Healthcare Provider Details

I. General information

NPI: 1992455760
Provider Name (Legal Business Name): IRINA TARDIF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST FL 4
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

14051 BEACH BLVD APT 2415
JACKSONVILLE FL
32250-1830
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-3335
  • Fax: 904-743-5309
Mailing address:
  • Phone: 321-507-7538
  • Fax: 904-743-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number181079
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: