Provider Demographics
NPI:1841574423
Name:TANNER, SARAH A (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:TANNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1938 E WATSON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3225
Mailing Address - Country:US
Mailing Address - Phone:623-947-5300
Mailing Address - Fax:623-847-5304
Practice Address - Street 1:5002 W GLENDALE AVE
Practice Address - Street 2:STE 104
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2756
Practice Address - Country:US
Practice Address - Phone:623-847-5300
Practice Address - Fax:623-847-5304
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2014-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4979363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical