BRIAN D TARDIF (NPI# 1164719076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164719076 |
| Entity Type | Individual |
| Full Name | BRIAN D TARDIF |
| Credential | PA |
| Practice Address |
10475 Centurion Pkwy N Suite 220 Jacksonville FL 32256-5003 |
| Mailing Address |
6500 Bowden Rd Suite 103 Jacksonville FL 32216-8070 |
| Practice Telephone | 9046340640 |
| Practice Fax Number | 9046340203 |
| Mailing Telephone | 9046340640 |
| Mailing Fax Number | 9046340203 |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2015-03-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA9106048 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
10475 CENTURION PKWY N SUITE 220 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32256-5003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265438493 | James Douglas Green Jr. | Specialist | 10475 Centurion Pkwy N, Ste 303, Jacksonville, FL 32256-5003 | 2005-06-22 |
| 1285170282 | Kelli D. Williams | Physician Assistant | 10475 Centurion Pkwy N, Suite 104, Jacksonville, FL 32256-5003 | 2017-01-13 |
| 1235593641 | Ryan M Funderburk | Audiologist | 10475 Centurion Pkwy N, Suite 303, Jacksonville, FL 32256-5003 | 2016-04-12 |
| 1275998908 | Se Orthopedic Specialists | Non-Pharmacy Dispensing Site | 10475 Centurion Pkwy N, Suite 220, Jacksonville, FL 32256-5003 | 2015-12-23 |
| 1821479650 | Kristen Edenfield | Audiologist | 10475 Centurion Pkwy N, #303, Jacksonville, FL 32256-5003 | 2015-06-17 |
| 1952789547 | Christopher Perez De Corcho | Physical Therapist | 10475 Centurion Pkwy N, #304, Jacksonville, FL 32256-5003 | 2015-05-14 |
| 1588059083 | Krista L Boniecki | Physical Therapist | 10475 Centurion Pkwy N, Suie 220, Jacksonville, FL 32256-5003 | 2015-04-01 |
| 1679970990 | Paul D Sturney | Physician Assistant | 10475 Centurion Pkwy N, Suite 220, Jacksonville, FL 32256-5003 | 2014-12-02 |
| 1326440801 | Healthcore Wellness, P.a. | Chiropractor | 10475 Centurion Pkwy N, Suite 201, Jacksonville, FL 32256-5003 | 2014-09-16 |
| 1902213770 | Tonya Goodson | Nurse Practitioner | 10475 Centurion Pkwy N, #203, Jacksonville, FL 32256-5003 | 2014-07-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841890464 | Alice Sanchez | Dietitian, Registered | 7643 Gate Parkway, Suite 104-1128, Jacksonville, FL 32256 | 2020-11-01 |
| 1093327702 | Oaktree Dental LLC | Clinic/Center | 14595 Philips Highway, Jacksonville, FL 32256 | 2020-08-24 |
| 1538787866 | Tywanna Council | Massage Therapist | 4720 Salisbury Road #102, Jacksonville, FL 32256 | 2020-07-13 |
| 1275155368 | Christy Orellana | Social Worker | 5011 Gate Parkway Bldg 100 Suite 100, Jacksonville, FL 32256 | 2020-05-11 |
| 1376175117 | Diane Stover | Case Manager/Care Coordinator | 7001 A. C. Skinner Parkway, Jacksonville, FL 32256 | 2020-02-10 |
| 1982235859 | Sandra Josefina Baez Nunez | Nurse Practitioner | 10739 Deerwood Park Blvd, Suite 200, Jacksonville, FL 32256 | 2020-01-30 |
| 1205476496 | Point Meadows Dental Center, Inc. | Dentist | 10915 Baymeadows Rd, #106, Jacksonville, FL 32256 | 2020-01-15 |
| 1598324113 | Dhaval Yogeshkumar Shah | Dentist | 8206 Philips Hwy., Suite 21, Jacksonville, FL 32256 | 2019-06-07 |
| 1003472499 | Dade Medical, Inc. | Durable Medical Equipment & Medical Supplies | 9143 Philips Highway Suite 270, Jacksonville, FL 32256 | 2019-05-13 |
| 1003479726 | Nichole Bashara | Behavior Technician | 8383 Baymeadows Rd, Jacksonville, FL 32256 | 2019-04-18 |
| Find all providers in zip 32256 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255858650 | John Matthew Dumas | Physician Assistant | 3640 Newcomb Rd, Jacksonville, FL 32218-1510 | 2017-08-25 |
| 1932432093 | Andrew Gibson | Physician Assistant | 12869 Dunes Ct, Jacksonville, FL 32225-3889 | 2009-09-08 |
| 1871556340 | Kevin Michael Cofran | Physician Assistant | 1838 Mcintosh Pl, Jacksonville, FL 32210-2224 | 2006-04-07 |
| 1811950272 | Jaclyn Michelle Tyo | Physician Assistant | 2627 Riverside Ave Ste 300, Jacksonville, FL 32204-4712 | 2006-04-07 |
| 1912969015 | Wendy Elizabeth Ashby | Physician Assistant | 3639 Darnall Pl, Jacksonville, FL 32217-4215 | 2006-04-04 |
| 1407839616 | Jennifer Renee Wren | Physician Assistant | 1820 Barrs St, Suite 701, Jacksonville, FL 32204-4742 | 2005-11-22 |
| 1962403949 | Katherine Elizabeth Stenberg Curry | Physician Assistant | 841 Prudential Dr, Ufjax - Pediatric Cardiothoracic Surgery, Jacksonville, FL 32207-8329 | 2005-08-02 |
| 1346848173 | Marisa Elaine Long | Physician Assistant | 836 Prudential Dr Ste 1001, Jacksonville, FL 32207-8337 | 2020-10-14 |
| 1235775438 | Jacqueline M Evans | Physician Assistant | 2 Shircliff Way Ste 605, Jacksonville, FL 32204-4762 | 2019-11-22 |
| 1992363733 | Lindsey Allison Baroch | Physician Assistant | 3627 University Blvd S Ste 550, Jacksonville, FL 32216-7401 | 2019-06-05 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32256 |
Please comment or provide details below to improve the information on BRIAN D TARDIF.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.