Individual
TANNER WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(888) 663-3488
Mailing address
PO BOX 198441, ATLANTA, GA 30384-8441
(813) 745-7365
(813) 449-8618
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
AA831
FL
367H00000X
Anesthesiologist Assistant
Primary
AA831
FL
Other
Enumeration date
09/08/2023
Last updated
02/19/2025
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