Organization
TANNER MEDICAL ENTERPRISES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILLICENT H TANNER (ADMINISTRATOR/OWNER)
(904) 241-2653
Entity
Organization
Contact information
Practice address
101 FLORIDA BLVD, NEPTUNE BEACH, FL 32266-4966
(904) 241-2653
(904) 246-6312
Mailing address
PO BOX 51595, JACKSONVILLE BEACH, FL 32240-1595
(904) 241-2653
(904) 246-6312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS4709
FL
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
OS4709
FL
2084P0802X
Addiction Psychiatry Physician
OS4709
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
068895900
—
FL
01
—
82622
BCBS
FL
Enumeration date
05/23/2010
Last updated
03/04/2013
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