Provider Demographics
NPI:1679742415
Name:TARDIO, NICOLE BERNADETTE (PA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:BERNADETTE
Last Name:TARDIO
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Gender:F
Credentials:PA
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Mailing Address - Street 1:853 BROADWAY
Mailing Address - Street 2:SUITE 701
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4703
Mailing Address - Country:US
Mailing Address - Phone:212-627-1004
Mailing Address - Fax:212-473-2309
Practice Address - Street 1:853 BROADWAY
Practice Address - Street 2:SUITE 701
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4703
Practice Address - Country:US
Practice Address - Phone:212-627-1004
Practice Address - Fax:212-473-2309
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2014-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY011987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant