Provider Demographics
NPI:1841264124
Name:TANNER, SCOTT LEE (CRNA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LEE
Last Name:TANNER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14046 W SIREN CT
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-5188
Mailing Address - Country:US
Mailing Address - Phone:863-446-0950
Mailing Address - Fax:
Practice Address - Street 1:14046 W SIREN CT
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-5188
Practice Address - Country:US
Practice Address - Phone:863-446-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR82029367500000X
FLARNP1707892367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2007OtherBCBS
FLG77578Medicare UPIN
FLG2007WMedicare ID - Type Unspecified