Graciela Susana Tanner, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

001710PA Issued in PR

Practice address

PO Box 11913
San Juan, PR 00922-1913

Phone

(787) 999-0753

NPI assigned

Jun 6, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1114768736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "A53 CALLE 4",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "006122525",
            "telephone_number": "727-225-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 11913",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009221913",
            "telephone_number": "787-999-0753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "GRACIELA",
        "middle_name": "SUSANA",
        "name_prefix": "Dr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-06",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "001710PA",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PR",
            "license": "001710PA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francine Loren Tait Avagnina
• Tait Neurology and Headache Medicine LLC
• Jessika Talavera, PH.D.
• Vivian M. Tamayo - Agrait, MD
• Cristian R Tampe-Moreno, M.D.
• Alejandro Tapia del Valle, DPT
• Melanie Tapia Hernandez
• Yanibel Marie Tapia Rosa, MD
• Nora Tapia-Anchondo, RN BSN
• Carmen M Tapia, PRACTICAL NURSE

• Medical Physician Assistant in San Juan, PR
• Providers in San Juan, PR by specialty
• Medical Physician Assistant in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.