Healthcare Provider Details

I. General information

NPI: 1508601634
Provider Name (Legal Business Name): JACOB TANNER BARB RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2024
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 LEGACY DR STE 1000
PLANO TX
75024-0417
US

IV. Provider business mailing address

7950 LEGACY DR STE 1000
PLANO TX
75024-0417
US

V. Phone/Fax

Practice location:
  • Phone: 972-943-6400
  • Fax:
Mailing address:
  • Phone: 972-943-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number255632
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number255632
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number255632
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number255632
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number255632
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number255632
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number255632
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberNHA-NHA-LIC-6721
License Number StateMT
# 9
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number255632
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: