Provider Demographics
NPI:1588764831
Name:TANNER, JOANNE L (CRNP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:L
Last Name:TANNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N STATE ST
Mailing Address - Street 2:MINUTE CLINIC
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1055
Mailing Address - Country:US
Mailing Address - Phone:570-587-1205
Mailing Address - Fax:
Practice Address - Street 1:101 N STATE ST
Practice Address - Street 2:MINUTE CLINIC
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1055
Practice Address - Country:US
Practice Address - Phone:570-587-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167883363LF0000X
NYF330813-1363LF0000X
PASP011353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF330813-1OtherSTATE LICENSE
PARN621843OtherSTATE LICENSE
VA0024167883OtherVIRGINIA NURSE PRACTITIONER LICENSE
PASP011353OtherCRNP STATE LICENSE
NY0229047-22OtherANCC
VA0001212410OtherVIRGINIA REGISTERED NURSE LICENSE
NY327036-1OtherSTATE LICENSE
PASP011353OtherCRNP STATE LICENSE