Tackett, Andrea Hardison

Tackett, Andrea Hardison is an individual health care provider with primary practice located at 1941 Johnson Ave Ste 101, San Luis Obispo CA 93401-4154. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Nuclear Cardiology. Allopathic & Osteopathic Physicians / Cardiovascular Disease is her primary health care specialty. Tackett, Andrea Hardison can be contacted via phone (805) 782-8844.

Contact Information

Primary practice address
1941 Johnson Ave Ste 101 San Luis Obispo CA 93401-4154
Phone: (805) 782-8844
Fax: (805) 782-8859
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X A116056 California
Allopathic & Osteopathic Physicians / Nuclear Cardiology 207UN0901X A116056 California

Profile Details

NPI number 1215138789
LBN Legal business name Tackett, Andrea Hardison
Credentials MD, FACC
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2007
Last updated Jun 25th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215138789 NPPES
California Other ZZZ28458Z BLUE SHIELD
California Other P00971250 BLUE SHIELD
California MEDICAID GR000068680 BLUE SHIELD

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