Provider Demographics
NPI:1477801249
Name:CARON, TAMMY J (RN, CNS)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:CARON
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4523 SPINNAKER LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49272-9624
Mailing Address - Country:US
Mailing Address - Phone:517-416-7545
Mailing Address - Fax:
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-416-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704160347364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health