Provider Demographics
NPI:1447724406
Name:TARCON, JAMES RICHARD (CRNA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RICHARD
Last Name:TARCON
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:11701 CENTRAL PARK WAY APT 1231
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3118
Mailing Address - Country:US
Mailing Address - Phone:414-344-8383
Mailing Address - Fax:
Practice Address - Street 1:3701 12TH ST N STE 202
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2253
Practice Address - Country:US
Practice Address - Phone:320-258-3090
Practice Address - Fax:320-258-3095
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2284367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered