Provider Demographics
NPI:1316094204
Name:TANNER, JENIFER L (MD)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:L
Last Name:TANNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:ONE VANTAGE WAY
Mailing Address - Street 2:NASHVILLE
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228
Mailing Address - Country:US
Mailing Address - Phone:615-329-4020
Mailing Address - Fax:615-329-9479
Practice Address - Street 1:400 N HIGHLAND AVE
Practice Address - Street 2:MURFREESBORO
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:800-596-3455
Practice Address - Fax:615-396-6963
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41779207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30000361Medicaid
TN30000361Medicare PIN