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General NPI Number Information
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NPI Number | 1871743963
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Entity Type | Individual
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Provider Name | JILL M. TANNER APRN
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Gender | Female
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 6150 DIAMOND CENTRE CT SUITE 1300
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City | FORT MYERS
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State | FL
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Zip | 33912-4367
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Country | US
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Telephone | 239-344-9786
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Fax | 239-344-9215
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Provider Business Mailing Address
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Address Line | 28608 SAN LUCAS LN UNIT 102
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-8312
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Country | US
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Telephone | 203-895-9680
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Fax | 239-344-9215
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 003903
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP9430928
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License Number State | FL
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