Provider Demographics
NPI:1831604800
Name:TANNER, KATIE L (FNP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:TANNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9331 S COLORADO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-7465
Mailing Address - Country:US
Mailing Address - Phone:303-795-8177
Mailing Address - Fax:
Practice Address - Street 1:9331 S COLORADO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7465
Practice Address - Country:US
Practice Address - Phone:303-795-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018876363LF0000X
COAPN.0993476-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily