Provider Demographics
NPI:1003866674
Name:TACK, BILLIE L (ARNP)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:L
Last Name:TACK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:L
Other - Last Name:HOLLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-246-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-246-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-067399363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01A8OtherJOHN DEERE HEALTH
084118OtherHEALTH ALLIANCE
222235OtherIOWA HEALTH SOLUTIONS
240863OtherMIDLANDS CHOICE
IA0498519Medicaid
IA35233OtherWELLMARK BC/BS
240863OtherMIDLANDS CHOICE
IA35233OtherWELLMARK BC/BS
P60770Medicare UPIN