Provider Demographics
NPI:1053841288
Name:TANT, AUBREE LAUREN (FNP-C)
Entity Type:Individual
Prefix:
First Name:AUBREE
Middle Name:LAUREN
Last Name:TANT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 APPLE BARRELL WAY
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30178-1634
Mailing Address - Country:US
Mailing Address - Phone:770-778-8018
Mailing Address - Fax:
Practice Address - Street 1:176 CHARLES HARDY PKWY UNIT C
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-1836
Practice Address - Country:US
Practice Address - Phone:678-945-8200
Practice Address - Fax:678-945-8209
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA204310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily