Provider Demographics
NPI:1518184829
Name:SUZAN TANNER PHD PA
Entity Type:Organization
Organization Name:SUZAN TANNER PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-461-8333
Mailing Address - Street 1:2103 CORAL WAY
Mailing Address - Street 2:SUITE 815
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2601
Mailing Address - Country:US
Mailing Address - Phone:305-461-8333
Mailing Address - Fax:305-461-8333
Practice Address - Street 1:2103 CORAL WAY
Practice Address - Street 2:SUITE 815
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2601
Practice Address - Country:US
Practice Address - Phone:305-461-8333
Practice Address - Fax:305-461-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 4982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty