Individual
ETHAN TANNER AUSTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT, CES
Contact information
Practice address
850 34TH ST S, ST PETERSBURG, FL 33711-2297
(904) 607-1418
Mailing address
6815 FOXTAIL PALM WAY APT 109, BRADENTON, FL 34210-7032
(904) 607-1418
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
7775
FL
2255A2300X
Athletic Trainer
Primary
—
VA
Other
Enumeration date
05/19/2025
Last updated
07/01/2026
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