Provider Demographics
NPI:1558712307
Name:SCHULTZ TANNER, KRISTINA (APRN, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SCHULTZ TANNER
Suffix:
Gender:F
Credentials:APRN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 OLD JEFFERSON RD BLDG 800
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-353-2990
Mailing Address - Fax:706-353-2992
Practice Address - Street 1:3320 OLD JEFFERSON RD BLDG 800
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-353-2990
Practice Address - Fax:706-353-2992
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN157317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003234315AMedicaid