Healthcare Provider Details

I. General information

NPI: 1104745744
Provider Name (Legal Business Name): JESSICA TATARCZUCH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD
ELK GROVE VILLAGE IL
60007-3361
US

IV. Provider business mailing address

1103 CAMDEN CT
GLENDALE HEIGHTS IL
60139-3756
US

V. Phone/Fax

Practice location:
  • Phone: 847-437-5500
  • Fax:
Mailing address:
  • Phone: 224-238-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.035865
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: