Individual
TARA LEIGH SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, CRNA
Contact information
Practice address
602 JACKSON ST, PETOSKEY, MI 49770-2220
(231) 348-2795
(231) 348-2031
Mailing address
602 JACKSON ST, PETOSKEY, MI 49770-2220
(231) 348-2795
(231) 348-2031
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
4704326900
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704326900
MI
Other
Enumeration date
09/05/2022
Last updated
05/06/2026
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