Provider Demographics
NPI:1073928321
Name:KRISE, TANZANICCA NICOLE (RN, SA-C)
Entity Type:Individual
Prefix:MRS
First Name:TANZANICCA
Middle Name:NICOLE
Last Name:KRISE
Suffix:
Gender:F
Credentials:RN, SA-C
Other - Prefix:
Other - First Name:TANZANICCA
Other - Middle Name:NICOLE
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3408 BLUESPRUCE WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3918
Mailing Address - Country:US
Mailing Address - Phone:615-969-3231
Mailing Address - Fax:615-962-9595
Practice Address - Street 1:3408 BLUESPRUCE WAY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-3918
Practice Address - Country:US
Practice Address - Phone:615-969-3231
Practice Address - Fax:615-962-9595
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN189296163W00000X
TN13-472246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist