Provider Demographics
NPI:1568484913
Name:THOMASON TANNER, BRANDY (CRNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:THOMASON TANNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:1500 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1602
Practice Address - Country:US
Practice Address - Phone:205-934-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-094513363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051523543OtherBLUE CROSS
AL051524952OtherBLUE CROSS
AL891008150Medicaid
AL051523540OtherBLUE CROSS
AL051523548OtherBLUE CROSS
AL051524951OtherBLUE CROSS
AL051524953OtherBLUE CROSS
AL891008460Medicaid
AL891008470Medicaid
AL051523541OtherBLUE CROSS
AL051523542OtherBLUE CROSS
AL051523546OtherBLUE CROSS
AL891008140Medicaid
AL891008170Medicaid
AL891008120Medicaid
AL051523545OtherBLUE CROSS
AL891008130Medicaid
AL891008450Medicaid
AL891008110Medicaid
AL891008160Medicaid