Healthcare Provider Details

I. General information

NPI: 1841574423
Provider Name (Legal Business Name): SARAH A TANNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 W GLENDALE AVE STE 104
GLENDALE AZ
85301-2756
US

IV. Provider business mailing address

1938 E WATSON DR
TEMPE AZ
85283-3225
US

V. Phone/Fax

Practice location:
  • Phone: 623-847-5300
  • Fax: 623-847-5304
Mailing address:
  • Phone: 623-947-5300
  • Fax: 623-847-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4979
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: