Provider Demographics
NPI:1104268408
Name:TANNER, REGINA (STNA)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 JERI AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1338
Mailing Address - Country:US
Mailing Address - Phone:614-257-0395
Mailing Address - Fax:614-333-6211
Practice Address - Street 1:2455 JERI AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1338
Practice Address - Country:US
Practice Address - Phone:614-257-0395
Practice Address - Fax:614-333-6211
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH362661031089E374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide