MEDICARE: MR. JEFFREY BRENT TANNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019017830	VA

General Provider Information

NPI Number	:	1598635898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY BRENT TANNER

Provider Business Mailing Address
First Line	:	1012 VALMIRE DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4730
Country	:	US
Telephone Number	:	239-220-8840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1492 S INDEPENDENCE BLVD STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5252
Country	:	US
Telephone Number	:	757-632-0974
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	11/11/2025

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