Provider Demographics
NPI:1093597239
Name:DENNISON, TARA MICHELE (MSN-ED, BSN, RN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELE
Last Name:DENNISON
Suffix:
Gender:F
Credentials:MSN-ED, BSN, RN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MICHELE
Other - Last Name:HIGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN-ED, BSN, RN
Mailing Address - Street 1:205 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICKAMAUGA
Mailing Address - State:GA
Mailing Address - Zip Code:30707-1430
Mailing Address - Country:US
Mailing Address - Phone:423-509-9254
Mailing Address - Fax:
Practice Address - Street 1:265 BICENTENNIAL TRL
Practice Address - Street 2:
Practice Address - City:ROCK SPRING
Practice Address - State:GA
Practice Address - Zip Code:30739-2306
Practice Address - Country:US
Practice Address - Phone:706-764-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169796163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health