| NPI | 1871604488 |
|---|---|
| Former Name | JOHNNA TANNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA1377) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC 015) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-01-30 |