Individual
MRS. TARA LYNN PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, MSN
Contact information
Practice address
1 COOPER PLZ, CAMDEN, NJ 08103-1461
(856) 342-2425
Mailing address
1 FEDERAL ST STE SW200, CAMDEN, NJ 08103-1155
(856) 356-4924
(856) 356-4710
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR11265000
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
NJ00305300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NJ00305300
STATE LICENSE
NJ
Enumeration date
06/01/2010
Last updated
04/11/2018
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