Individual
TANNER SEAN HARVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
472 POLARIS AVENUE, VIRGINIA BEACH, VA 23461
(757) 862-2715
Mailing address
1MRB BAS, APO, AA 92010
(760) 500-0719
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710I1002X
MILITARY HEALTH CARE PROVIDER - INDEPENDENT DUTY CORPSMAN
NC
Enumeration date
03/20/2020
Last updated
06/26/2023
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