MEDICARE: KRISTI LYNN TARDIF PA-C

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
1	363A00000X	Physician Assistant	PA9106032	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548479215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI LYNN TARDIF PA-C

Provider Business Mailing Address
First Line	:	6800 SOUTHPOINT PKWY STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8203
Country	:	US
Telephone Number	:	904-634-0640
Fax Number	:	904-634-0203

Provider Business Practice Location Address
First Line	:	2627 RIVERSIDE AVE STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4717
Country	:	US
Telephone Number	:	904-634-0640
Fax Number	:	904-634-0203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	11/12/2025

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