Provider Demographics
NPI:1578072872
Name:TARA GANN DNP
Entity Type:Organization
Organization Name:TARA GANN DNP
Other - Org Name:GANN HEALTHCARE AND SLEEP LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-951-2189
Mailing Address - Street 1:405 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5345
Mailing Address - Country:US
Mailing Address - Phone:928-472-6000
Mailing Address - Fax:844-752-8246
Practice Address - Street 1:405 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5345
Practice Address - Country:US
Practice Address - Phone:928-472-6000
Practice Address - Fax:844-752-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7879363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty