Provider Demographics
NPI:1194159491
Name:TANNER, TINA A
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:A
Last Name:TANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2929
Mailing Address - Country:US
Mailing Address - Phone:740-252-7011
Mailing Address - Fax:
Practice Address - Street 1:1237 GARDEN ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2929
Practice Address - Country:US
Practice Address - Phone:740-252-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist
No1744R1102XOther Service ProvidersSpecialistResearch Study
No251B00000XAgenciesCase Management
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider