MEDICARE: TAMARA BRECKON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209017135	IL

General Provider Information

NPI Number	:	1740777093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA BRECKON

Provider Business Mailing Address
First Line	:	201 E MADISON ST STE 328
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-5131
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 E STATE ST STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2125
Country	:	US
Telephone Number	:	217-408-1195
Fax Number	:	217-408-1231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2018
Last Update Date	:	06/05/2025

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Directions to “ TAMARA BRECKON ” Practice Location

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