Provider Demographics
NPI:1710016050
Name:FLEMING, TANNIA LYN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TANNIA
Middle Name:LYN
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TANNIA
Other - Middle Name:LYN
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:SUITE 2360
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-6406
Mailing Address - Fax:503-494-5050
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-9888
Practice Address - Fax:503-494-1760
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01209363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant