Healthcare Provider Details

I. General information

NPI: 1841264124
Provider Name (Legal Business Name): SCOTT LEE TANNER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14046 W SIREN CT
CRYSTAL RIVER FL
34429-5188
US

IV. Provider business mailing address

14046 W SIREN CT
CRYSTAL RIVER FL
34429-5188
US

V. Phone/Fax

Practice location:
  • Phone: 863-446-0950
  • Fax:
Mailing address:
  • Phone: 863-446-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR82029
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1707892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: