Provider Demographics
NPI:1699366195
Name:SUMMERVILLE, TANNA MORRIS (RN)
Entity Type:Individual
Prefix:MRS
First Name:TANNA
Middle Name:MORRIS
Last Name:SUMMERVILLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5902 PRINTERY ST UNIT 105
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-1452
Mailing Address - Country:US
Mailing Address - Phone:843-450-7128
Mailing Address - Fax:
Practice Address - Street 1:5902 PRINTERY ST UNIT 105
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-1452
Practice Address - Country:US
Practice Address - Phone:843-450-7128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9354213163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse