Individual
DR. JOHN CALVIN TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
340 16TH AVE N STE A, JACKSONVILLE BEACH, FL 32250-4819
(904) 241-2653
(904) 758-0559
Mailing address
PO BOX 51595, JACKSONVILLE BEACH, FL 32240-1595
(904) 571-9439
(904) 758-0559
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS0004709
FL
207QA0401X
Addiction Medicine (Family Medicine) Physician
OS0004709
FL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
OS4709
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010659200
—
FL
05
—
068895900
—
FL
01
—
080025596
MEDICARE RAILROAD
FL
01
—
82622
BCBS
FL
Enumeration date
06/23/2006
Last updated
05/16/2025
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