Provider Demographics
NPI:1538795679
Name:HARVEY, TANNER SEAN (SOIDC)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:SEAN
Last Name:HARVEY
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1MRB BAS
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:92010
Mailing Address - Country:US
Mailing Address - Phone:760-500-0719
Mailing Address - Fax:
Practice Address - Street 1:472 POLARIS AVENUE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23461
Practice Address - Country:US
Practice Address - Phone:757-862-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1710I1002XOtherMILITARY HEALTH CARE PROVIDER - INDEPENDENT DUTY CORPSMAN