Provider Demographics
NPI:1487394029
Name:TREGUBOVA KHILKEVICH, YANA (FNP-BC)
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:TREGUBOVA KHILKEVICH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23260 BIGLER ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2712
Mailing Address - Country:US
Mailing Address - Phone:818-267-4154
Mailing Address - Fax:
Practice Address - Street 1:28720 ROADSIDE DR # 333
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3316
Practice Address - Country:US
Practice Address - Phone:818-267-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily