Provider Demographics
NPI:1528520442
Name:TASSI, JENNA (DO)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:TASSI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:BERNDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:LOYOLA UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:2160 S. FIRST AVE
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17705 HUTCHINS DR STE 250
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4103
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:952-401-8243
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1528520442208000000X
IL036161210208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics