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NPI Code Detail

MEDICARE: BERNARD P TADDA FNP

MEDICARE: BERNARD P TADDA FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerA080476IA
2363LF0000XFamily Nurse Practitioner209002893IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15201162OTHERIACONTROLLED SUBSTANCE#
2421060724OTHERIABILLING TAX ID# FOR CHC
3IA0133OTHERIAJOHN DEERE EDI#
4079606OTHERHEALTH ALLIANCE
502253OTHERIAIA BCBS SEEN IN DAVENPORT
642106072433OTHERIAJOHN DEERE HEALTH
7S55307OTHERUPIN

General Provider Information

NPI Number : 1417943903
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNARD P TADDA FNP
Provider Business Mailing Address
First Line : 500 W RIVER DR
Second Line :
City : DAVENPORT
State : IA
Zip : 52801-1014
Country : US
Telephone Number : 563-336-3000
Fax Number : 563-336-3125
Provider Business Practice Location Address
First Line : 500 W RIVER DR
Second Line :
City : DAVENPORT
State : IA
Zip : 52801-1014
Country : US
Telephone Number : 563-336-3000
Fax Number : 563-336-3125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 03/07/2023

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