Active NPI
Tatia Khardziani
- Nurse Practitioner
- Lincoln Park, NJ
National Provider Identifier
1942164520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 26NR23155600
- Practice address
- 5 Squire Dr
Lincoln Park, NJ 07035-1511 - Phone
- (862) 591-8370
- NPI assigned
- Dec 9, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 26NR23155600 | NJ | Primary |
Addresses
Primary practice location
5 Squire Dr
Lincoln Park, NJ 07035-1511
Mailing address
5 Squire Dr
Lincoln Park, NJ 07035-1511
Phone (862) 591-8370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NR23155600 | NJ | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1765238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765497600000",
"number": "1942164520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 SQUIRE DR",
"city": "LINCOLN PARK",
"state": "NJ",
"postal_code": "070351511",
"telephone_number": "862-591-8370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 SQUIRE DR",
"city": "LINCOLN PARK",
"state": "NJ",
"postal_code": "070351511",
"telephone_number": "862-591-8370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHARDZIANI",
"first_name": "TATIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-12-09",
"last_updated": "2025-12-12",
"certification_date": "2025-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NJ",
"license": "26NR23155600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.