Healthcare Provider Details

I. General information

NPI: 1528520442
Provider Name (Legal Business Name): JENNA TASSI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA BERNDT

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/23/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17705 HUTCHINS DR STE 250
MINNETONKA MN
55345-4103
US

IV. Provider business mailing address

LOYOLA UNIVERSITY MEDICAL CENTER 2160 S. FIRST AVE
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-8300
  • Fax: 952-401-8243
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1528520442
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036161210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: