Individual
TARA LISA WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, APN-BC
Contact information
Practice address
333 STADIUM BLVD., SUITE B, JONESBORO, AR 72401
(870) 972-2054
Mailing address
4203 SANDSTONE DR, JONESBORO, AR 72401-7833
(870) 910-0436
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A01852
AR
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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