Provider Demographics
NPI:1114678091
Name:KARST, TANTAH ANNA (CARE MANAGER 1)
Entity Type:Individual
Prefix:
First Name:TANTAH
Middle Name:ANNA
Last Name:KARST
Suffix:
Gender:F
Credentials:CARE MANAGER 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3610
Mailing Address - Country:US
Mailing Address - Phone:707-961-0172
Mailing Address - Fax:
Practice Address - Street 1:137 E OAK ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3610
Practice Address - Country:US
Practice Address - Phone:707-961-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator