Healthcare Provider Details

I. General information

NPI: 1184320988
Provider Name (Legal Business Name): TANA LOMBARDO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 HUNTINGTON DR N
ALGONQUIN IL
60102-4419
US

IV. Provider business mailing address

795 ELETSON DR
CRYSTAL LAKE IL
60014-2812
US

V. Phone/Fax

Practice location:
  • Phone: 224-348-7981
  • Fax:
Mailing address:
  • Phone: 630-715-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.027804
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: