MEDICARE: BRENDA JJ TALARICO 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	9497	MN

General Provider Information

NPI Number	:	1891767083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA JJ TALARICO PA C

Provider Business Mailing Address
First Line	:	8100 34TH AVE S
Second Line	:	21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-1672
Country	:	US
Telephone Number	:	952-883-7961
Fax Number	:	952-883-5395

Provider Business Practice Location Address
First Line	:	6845 LEE AVE N
Second Line	:	MAIL STOP 31400A
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1717
Country	:	US
Telephone Number	:	763-569-0300
Fax Number	:	763-569-0311

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/08/2007

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