Provider Demographics
NPI:1366724817
Name:MARION, TARA LEIGH (NNP)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LEIGH
Last Name:MARION
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 SILOAM RD
Mailing Address - Street 2:
Mailing Address - City:SILOAM
Mailing Address - State:NC
Mailing Address - Zip Code:27047-9193
Mailing Address - Country:US
Mailing Address - Phone:336-374-3338
Mailing Address - Fax:
Practice Address - Street 1:6960 SILOAM RD
Practice Address - Street 2:
Practice Address - City:SILOAM
Practice Address - State:NC
Practice Address - Zip Code:27047-9193
Practice Address - Country:US
Practice Address - Phone:336-374-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005289363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal