Healthcare Provider Details

I. General information

NPI: 1245865104
Provider Name (Legal Business Name): MR. MICHAEL ROBERT TAPIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 24TH ST STE 124
ROCK ISLAND IL
61201-5394
US

IV. Provider business mailing address

2570 24TH ST STE 124
ROCK ISLAND IL
61201-5394
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-3670
  • Fax:
Mailing address:
  • Phone: 309-779-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberH159862
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number209021644
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number128262
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041409388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: