Provider Demographics
NPI:1962563940
Name:TANNER, BARBARA COLLINS (FNP)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:COLLINS
Last Name:TANNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:BARBARA
Other - Middle Name:JANET
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 EAST KING HWY
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288
Mailing Address - Country:US
Mailing Address - Phone:336-623-9711
Mailing Address - Fax:336-623-2434
Practice Address - Street 1:134 NORTH PIERCE STREET
Practice Address - Street 2:MOREHEAD HIGH SCHOOL STUDENT HEALTH CENTER
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288
Practice Address - Country:US
Practice Address - Phone:336-623-3699
Practice Address - Fax:336-623-3699
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000157Medicaid
NC1241LOtherBLUE CROSS BLUE SHIELD
NC7000157Medicaid