Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ivan Brandon Tanner

Individual provider Physician Assistant · NPI 1831044106

Ivan Brandon Tanner is a Physician Assistant in Melbourne, Florida. Qualified in 2024, 2 years ago. Licensed in Florida.

Years since qualifying
2
Licensed in
FL
In the registry since
2026

Practice location Address checks out

2100 N Wickham Rd
Melbourne, FL 32935-8110
Phone: (321) 752-7100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9121206 (FL)

Record details

NPI number1831044106
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 3, 2026
Last updated in NPPESMarch 3, 2026
Certification dateMarch 3, 2026
Mailing address2100 N Wickham Rd, Melbourne, FL 32935-8110

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated

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