Provider Demographics
NPI:1881196715
Name:TANNER, ANDREA THOMAS (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:THOMAS
Last Name:TANNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 WHITEMARSH WAY
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-5200
Mailing Address - Country:US
Mailing Address - Phone:678-372-1721
Mailing Address - Fax:678-372-1721
Practice Address - Street 1:1302 DRAYTON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6913
Practice Address - Country:US
Practice Address - Phone:912-443-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily