Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mariya Tkachenko, CNP

Individual provider Nurse Practitioner · NPI 1295565679

Mariya Tkachenko, CNP is a Nurse Practitioner in Shakopee, Minnesota. Qualified in 2024, 2 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
2
Licensed in
MN
In the registry since
2024
Specialties on file
2
What do these letters mean?
CNP — Certified Nurse Practitioner
A certified nurse practitioner.

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Practice location Address checks out

1415 Saint Francis Ave
Shakopee, MN 55379-3374
Phone: (952) 993-7750
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 11902 (MN)
Nurse Practitioner Taxonomy 363L00000X · Licence 11902 (MN)

Record details

NPI number1295565679
Entity typeIndividual (Type 1)
GenderFemale
Credentials CNP
Sole proprietorNo
NPI enumeratedAugust 1, 2024
Last updated in NPPESSeptember 9, 2024
Certification dateSeptember 9, 2024
Mailing address8170 33rd Ave S # Ms 21110q, Bloomington, MN 55425-4516

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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