Individual
JANE FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 974-2918
(813) 974-3326
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP675742
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y6960
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/30/2006
Last updated
01/11/2008
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