Healthcare Provider Details

I. General information

NPI: 1689016636
Provider Name (Legal Business Name): BRIAN K TANNER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE RD
DEERFIELD BEACH FL
33064-3502
US

IV. Provider business mailing address

690 CANTON ST STE 325
WESTWOOD MA
02090-2324
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-8300
  • Fax:
Mailing address:
  • Phone: 781-407-7713
  • Fax: 781-407-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-115992
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN329135
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11041329
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-OA10844
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number791145
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN10004453
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC-APN.0104878-C-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: