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General NPI Number Information
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NPI Number | 1861416547
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Entity Type | Individual
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Provider Name | KRISTIE LYNN TADDIE D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 6021 142ND AVE N
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City | CLEARWATER
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State | FL
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Zip | 33760-2822
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Country | US
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Telephone | 727-796-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 233 OSCEOLA AVE
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City | ORMOND BEACH
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State | FL
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Zip | 32176-6638
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Country | US
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Telephone | 386-672-6424
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Fax | 386-672-5251
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901002145
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3265
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License Number State | FL
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