Provider Demographics
NPI:1366421059
Name:PICOT, TATIANA WELLENS (DPM, PHD)
Entity type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:WELLENS
Last Name:PICOT
Suffix:
Gender:F
Credentials:DPM, PHD
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:A
Other - Last Name:WELLENS-BRUSCHAYT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 6TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4630
Mailing Address - Country:US
Mailing Address - Phone:863-299-4551
Mailing Address - Fax:863-299-2310
Practice Address - Street 1:101 6TH ST NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4630
Practice Address - Country:US
Practice Address - Phone:863-299-4551
Practice Address - Fax:863-299-2310
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2760213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7741073OtherAETNA PROVIDER #
FL65624OtherBCBS PROVIDER#
FLPO2760OtherFLORIDA LICENSE NUMBER
FLPO2760OtherFLORIDA LICENSE NUMBER