Provider Demographics
NPI:1205188349
Name:GUERIN, TANIS E (PA-C)
Entity Type:Individual
Prefix:
First Name:TANIS
Middle Name:E
Last Name:GUERIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TANIS
Other - Middle Name:
Other - Last Name:MCCOWAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-3251
Mailing Address - Fax:215-615-5055
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-3251
Practice Address - Fax:215-615-5055
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC-50000844363AM0700X
PAMA063270363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical