Basic Information
| Provider Information | |||||||||
| NPI: | 1619143286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANNER | ||||||||
| FirstName: | DEBORAH | ||||||||
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| Credential: | ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 N CAMPBELL AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857191563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206248935 | ||||||||
| FaxNumber: | 5208382266 | ||||||||
| Practice Location | |||||||||
| Address1: | 198 S CORONADO DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856356354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204170542 | ||||||||
| FaxNumber: | 5204170581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2008 | ||||||||
| LastUpdateDate: | 12/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | AP3006 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 336100 | 05 | AZ | MEDICAID |