Healthcare Provider Details

I. General information

NPI: 1215138789
Provider Name (Legal Business Name): ANDREA HARDISON TACKETT MD, FACC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 VIBORG RD STE 205
SOLVANG CA
93463-3226
US

IV. Provider business mailing address

PO BOX 689
SANTA BARBARA CA
93102-0689
US

V. Phone/Fax

Practice location:
  • Phone: 805-324-9707
  • Fax: 805-749-2907
Mailing address:
  • Phone: 805-324-9707
  • Fax: 805-749-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA116056
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA116056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: