MRS. TATIANA MUDRENKO PA
NPI 1417513490
Physician Assistant - Surgical in Roseville, CA

Active since May 15, 2019PECOS EnrolledAccepts Medicare Assignment
1600 EUREKA RD, ROSEVILLE, CA 95661(877) 457-4772 Get Directions Write a Review

NPPES record last updated: January 11, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 11, 2022, May 15, 2019 (2 updates tracked since 2019).

About Mrs. Tatiana Mudrenko Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. TATIANA MUDRENKO PA (NPI 1417513490) is an individual surgical provider in Roseville, California and active in the NPI registry since May 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1417513490
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NameMRS. TATIANA MUDRENKOCredential: PA
Location Address1600 EUREKA RDRoseville, CA 95661-3027
Mailing Address2555 Newcastle RdNewcastle, CA 95658-9751
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateMay 15, 2019
Last NPPES UpdateJanuary 11, 20222 updates tracked since enumeration
NPI 1417513490 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
1600 EUREKA RD, Roseville, CA 95661

Other Names 1

Other Name (5)Tatiana Condriuc Pa-c

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Mrs. Tatiana Mudrenko Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID648685206
PECOS Enrollment IDI20210212002453
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Urology
1600 EUREKA RD
ROSEVILLE, CA 95661
Pharmacist
1600 EUREKA RD
ROSEVILLE, CA 95661
Physical Therapist
1600 EUREKA RD
ROSEVILLE, CA 95661
Hospitalist
1600 EUREKA RD
ROSEVILLE, CA 95661
Internal Medicine
1600 EUREKA RD
ROSEVILLE, CA 95661
Nurse Practitioner (Women's Health)
1600 EUREKA RD, WOMEN'S HEALTH , PERMANENTE MEDICAL GROUP
ROSEVILLE, CA 95661
Pediatrics (Pediatric Hematology-Oncology)
1600 EUREKA RD
ROSEVILLE, CA 95661
Pharmacist
1600 EUREKA RD
ROSEVILLE, CA 95661

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tatiana Mudrenko's NPI number?

The NPI number for Tatiana Mudrenko is 1417513490. It was assigned to this individual provider in the NPPES registry on May 15, 2019. The provider is also known as Tatiana Condriuc Pa-C.

Where is Tatiana Mudrenko located?

Tatiana Mudrenko practices at 1600 Eureka Rd, Roseville, CA 95661. The listed phone number is (877) 457-4772.

What is Tatiana Mudrenko's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Tatiana Mudrenko enrolled in Medicare?

Yes. Tatiana Mudrenko is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Tatiana Mudrenko was last updated on January 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.