Individual
TARA GANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
405 W MAIN ST STE B, PAYSON, AZ 85541-5345
(928) 472-6000
(844) 752-8246
Mailing address
1503 W COUNTRY CLUB DR, PAYSON, AZ 85541-4611
(928) 951-2189
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AP7879
AZ
Other
Enumeration date
06/10/2015
Last updated
09/13/2019
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