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General NPI Number Information
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NPI Number | 1013471929
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Entity Type | Individual
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Provider Name | REBECCA BRENNAN TADLOCK NP
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Gender | Female
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 7401 MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77030-4509
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Country | US
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Telephone | 833-520-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 SETON CENTER PKWY STE 115
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City | AUSTIN
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State | TX
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Zip | 78759-5753
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Country | US
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Telephone | 346-440-0624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 203432
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1194580
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License Number State | TX
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