Provider Demographics
NPI:1124116504
Name:TYNDALL, KRISTINA ANN (APRN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 PINE LAKE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5497
Mailing Address - Country:US
Mailing Address - Phone:402-420-1212
Mailing Address - Fax:402-328-0961
Practice Address - Street 1:3901 PINE LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5497
Practice Address - Country:US
Practice Address - Phone:402-420-1212
Practice Address - Fax:402-328-0961
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110738363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052796712Medicaid
NE01942OtherBLUE SHIELD OF NEBRASKA
NE098203Medicare PIN