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General NPI Number Information
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NPI Number | 1891614145
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Entity Type | Individual
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Provider Name | THOMAS JAMES TANNER
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Gender | Male
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 2040 N DIXIE HWY
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City | WILTON MANORS
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State | FL
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Zip | 33305-2255
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Country | US
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Telephone | 954-463-9005
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Fax |
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Provider Business Mailing Address
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Address Line | 3091 N COURSE DR APT 110
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City | POMPANO BEACH
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State | FL
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Zip | 33069-6207
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Country | US
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Telephone | 954-709-6674
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2652562
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License Number State | FL
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