DR. TARA L BROADWATER (NPI# 1255310298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255310298 |
| Entity Type | Individual |
| Full Name | DR. TARA L BROADWATER |
| Credential | MD |
| Practice Address |
3647 Windtree Ct Eagan MN 55123-1314 |
| Practice Telephone | 5073041899 |
| Mailing Telephone | 5073041899 |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2013-07-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 40655 | MN | Allopathic & Osteopathic Physicians |
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
40655 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | PREFFERED ONE | NA2951032151 | 01 |
| IA | MEDICAID | 0573816 | 01 |
| MN | BCBS | 388R8BU | 01 |
| RR MEDICARE | P00138242 | 01 | |
| MN | UCARE | 124673 | 01 |
| CHAMPUS | 41084933956001C212 | 01 | |
| MN | HEALTH PARTNERS | HP36174 | 01 |
| MN | AMERICAS PPO | 1965380 | 01 |
| MN | 526011600 | 05 |
| Street Address |
3647 WINDTREE CT |
| City | EAGAN |
| State | MN |
| Zip Code | 55123-1314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053828467 | Hilltop Family Chiropractic Center Pa | Chiropractor | 1121 Town Centre Drive Suite 202, Eagan, MN 55123 | 2018-01-08 |
| 1922452507 | Jacob Zimmerman | Counselor | 3450 O'leary Ln., Eagan, MN 55123 | 2016-04-20 |
| 1316320971 | K-squared Fitness, L.L.C. | Public Health or Welfare | 1100 Cliff Rd, Eagan, MN 55123 | 2015-07-01 |
| 1346683687 | Joshua M Dorn | Allergy & Immunology | 3460 Promenade Ave, Eagan, MN 55123 | 2013-04-16 |
| 1700172350 | Mary Christine Mcnabney | Nurse Practitioner | 610 Opperman Drive, D4 Health Center, Your Wellbeing Health Center, Eagan, MN 55123 | 2011-06-22 |
| 1033353669 | Todd Borstad | Social Worker | 3450 O'leary Lane, Eagan, MN 55123 | 2009-04-27 |
| 1821025271 | Mngi Endoscopy LLC | Clinic/Center | 1185 Town Centre Drive, Eagan, MN 55123 | 2006-06-28 |
| 1780620120 | Cindy Eileen Wood | Audiologist | 3440 Oleary Lane, 240, Eagan, MN 55123 | 2006-06-22 |
| 1609845742 | Jeffery R Dichter | Internal Medicine | 849 Govern Circle, Saint Paul, MN 55123 | 2006-03-14 |
| 1891269155 | Elise Broderick Quam | Social Worker | 3450 Oleary Ln, Eagan, MN 55123 | 2019-01-18 |
| Find all providers in zip 55123 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841243631 | Bryan J Schwieters | Psychiatry & Neurology | 2781 Pilot Knob Rd, Eagan, MN 55121-1119 | 2006-05-19 |
| 1548486590 | Schwieters Medical Pllc | Psychiatry & Neurology | 2781 Pilot Knob Rd, Eagan, MN 55121-1119 | 2007-04-18 |
| 1912004607 | John Robert Shirriff | Psychiatry & Neurology | 3460 Washington Drive, Suite 200, Eagan, MN 55122-1338 | 2006-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588277677 | Emily Tonkin, LLC | Psychiatry & Neurology | 825 Nicollet Mall Ste 1246, Minneapolis, MN 55402-2702 | 2020-08-28 |
| 1083243182 | Blake Novy | Psychiatry & Neurology | 200 1st St Sw Dept Of, Rochester, MN 55905-0001 | 2020-04-02 |
| 1174156152 | Actify Neurotherapies, Pllc | Psychiatry & Neurology | 115 Elm St Ste I, Farmington, MN 55024-1031 | 2020-02-18 |
| 1336771591 | Paul George Wawin | Psychiatry & Neurology | 712 Cascade St. S. Lake Region Healthcare, Fergus Falls, MN 56537 | 2020-02-06 |
| 1912537721 | Psy-fi Tms | Psychiatry & Neurology | 6504 Creek Dr, Edina, MN 55439-1208 | 2020-01-21 |
| 1821637869 | Psychopharmacology Consultant LLC | Psychiatry & Neurology | 1082 Highway 3 S, Northfield, MN 55057-3088 | 2019-12-21 |
| 1770120933 | Dr. Lisa Etherapy | Psychiatry & Neurology | 3539 Douglas Dr N, Minneapolis, MN 55422-2415 | 2019-12-06 |
| 1225673411 | Osetohamen Elizabeth Agene | Psychiatry & Neurology | 5701 Shingle Creek Pkwy Ste 115, Minneapolis, MN 55430-2485 | 2019-11-12 |
| 1700319456 | Kristin Nguyen | Psychiatry & Neurology | 1301 W Center St, Rochester, MN 55902-0333 | 2017-04-10 |
| 1295198539 | Daniel Janiczak | Psychiatry & Neurology | 701 Park Ave. B5 118, Hencepin County Medical Center Department of Psychiatry, Minneapolis, MN 55415 | 2016-04-04 |
| Find all providers with the same taxonomy | ||||
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| 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.