Provider Demographics
NPI:1437147444
Name:TANNER, TANYA S (PHD APN CNM PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:S
Last Name:TANNER
Suffix:
Gender:F
Credentials:PHD APN CNM PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11164 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3918
Mailing Address - Country:US
Mailing Address - Phone:303-918-9828
Mailing Address - Fax:
Practice Address - Street 1:80 GARDEN CTR STE 138
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1790
Practice Address - Country:US
Practice Address - Phone:720-415-0101
Practice Address - Fax:833-907-2210
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2154367A00000X
COAPN.0996437-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90409523Medicaid
CO90409523Medicaid
COC810274Medicare PIN