Provider Demographics
NPI:1962100768
Name:KURTZ, SHANTINA MARIE (NP)
Entity type:Individual
Prefix:
First Name:SHANTINA
Middle Name:MARIE
Last Name:KURTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANTINA
Other - Middle Name:MARIE
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3902 N BRECKENRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-4350
Mailing Address - Country:US
Mailing Address - Phone:931-444-4880
Mailing Address - Fax:
Practice Address - Street 1:3902 N BRECKENRIDGE CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-4350
Practice Address - Country:US
Practice Address - Phone:931-444-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily