| Doctor Name: | TARA GANN |
| NPI Number: | 1043691520 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | TAP7879 |
| Business Practice Address: | 708 S Coeur D Alene Ln Ste B Payson, AZ - 855415662 |
| Business Phone Number: | 9284688610 |
| Business Fax Number: | |
| Mailing Address: | 1503 W Country Club Dr, PAYSON |
| State: | AZ |
| Postal Code: | 855414611 |
| Phone Number: | 9289512189 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2015 |
| NPI Last Update Date: | 06/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | TAP7879 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |