Provider Demographics
NPI:1942541073
Name:TANNER, SAMANTHA E (MS, MSHRM)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:E
Last Name:TANNER
Suffix:
Gender:F
Credentials:MS, MSHRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5886
Mailing Address - Country:US
Mailing Address - Phone:407-257-9223
Mailing Address - Fax:
Practice Address - Street 1:296 ROSE DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5886
Practice Address - Country:US
Practice Address - Phone:407-257-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health