MEDICARE: KATIE L TANNER FNP-C

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	363LF0000X	Family Nurse Practitioner	209018876	IL
2	363LF0000X	Family Nurse Practitioner	APN.0993476-NP	CO

General Provider Information

NPI Number	:	1831604800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE L TANNER FNP-C

Provider Business Mailing Address
First Line	:	9331 S COLORADO BLVD STE 100
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-7465
Country	:	US
Telephone Number	:	303-795-8177
Fax Number	:

Provider Business Practice Location Address
First Line	:	9331 S COLORADO BLVD STE 100
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-7465
Country	:	US
Telephone Number	:	303-795-8177
Fax Number	:

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

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	10/27/2022

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