Provider Demographics
NPI:1578739959
Name:TANNER, LISA ELLEN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ELLEN
Last Name:TANNER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5743
Mailing Address - Country:US
Mailing Address - Phone:813-315-9850
Mailing Address - Fax:813-315-9837
Practice Address - Street 1:522 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5743
Practice Address - Country:US
Practice Address - Phone:813-315-9850
Practice Address - Fax:813-315-9837
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY-1204231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist