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General NPI Number Information
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NPI Number | 1518184829
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Entity Type | Organization
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Legal Business Name | SUZAN TANNER PHD PA
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2103 CORAL WAY SUITE 815
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City | CORAL GABLES
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State | FL
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Zip | 33145-2601
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Country | US
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Telephone | 305-461-8333
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Fax | 305-461-8333
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Provider Business Mailing Address
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Address Line | 2103 CORAL WAY SUITE 815
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City | CORAL GABLES
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State | FL
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Zip | 33145-2601
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Country | US
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Telephone | 305-461-8333
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Fax | 305-461-8333
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUZAN TANNER
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Credential | PHD
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Telephone | 305-461-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 4982
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License Number State | FL
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