Provider Demographics
NPI:1902200330
Name:TANNER, BRITTNEY C (CRNP)
Entity Type:Individual
Prefix:MS
First Name:BRITTNEY
Middle Name:C
Last Name:TANNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:BRITTNEY
Other - Middle Name:C
Other - Last Name:DIMEGLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-724-6780
Mailing Address - Fax:717-724-6781
Practice Address - Street 1:4300 LONDONDERRY RD STE 302
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5317
Practice Address - Country:US
Practice Address - Phone:717-724-6780
Practice Address - Fax:717-724-6781
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014904363LG0600X, 363L00000X
IL209011886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103037642Medicaid
PA103037642Medicaid