Provider Demographics
NPI:1619143286
Name:TANNER, DEBORAH (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 N CAMPBELL AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-624-8935
Mailing Address - Fax:520-838-2266
Practice Address - Street 1:198 S CORONADO DR
Practice Address - Street 2:SUITE A
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6354
Practice Address - Country:US
Practice Address - Phone:520-417-0542
Practice Address - Fax:520-417-0581
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3006363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ336100Medicaid
AZZ122014Medicare PIN