Provider Demographics
NPI:1588090005
Name:TAGWERKER, KRISTINE (CRNA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:TAGWERKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:ISOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:858-249-6751
Mailing Address - Fax:
Practice Address - Street 1:700 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3923
Practice Address - Country:US
Practice Address - Phone:760-738-7830
Practice Address - Fax:760-738-7834
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128437367500000X
CA4409367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered