Provider Demographics
NPI:1295387751
Name:TANNER, BETSY ERIN (MSN-FNP, BC)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:ERIN
Last Name:TANNER
Suffix:
Gender:F
Credentials:MSN-FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 LONGHORN RD
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-7639
Mailing Address - Country:US
Mailing Address - Phone:912-269-8467
Mailing Address - Fax:
Practice Address - Street 1:2505 LONGHORN RD
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-7639
Practice Address - Country:US
Practice Address - Phone:912-269-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227397363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner