Individual
CARLY TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2835 W DE LEON ST STE 103, TAMPA, FL 33609-4130
(813) 875-7333
(813) 875-8833
Mailing address
151 SOUTHHALL LN, STE 300, MAITLAND, FL 32751-7176
(407) 875-2080
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9105781
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004349100
—
FL
Enumeration date
02/18/2011
Last updated
07/09/2019
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