Provider Demographics
NPI:1508898610
Name:RENNER, JANICE (PA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:RENNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-4380
Mailing Address - Country:US
Mailing Address - Phone:423-472-2273
Mailing Address - Fax:423-472-8059
Practice Address - Street 1:1995 KEITH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4380
Practice Address - Country:US
Practice Address - Phone:423-472-2273
Practice Address - Fax:423-472-8059
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant