Provider Demographics
NPI:1235114000
Name:TINTZMAN, KERRY J (ANP)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:J
Last Name:TINTZMAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:JEAN
Other - Last Name:STRICKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:STE C-416
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-258-4430
Mailing Address - Fax:907-258-4435
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:STE C-416
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-258-4430
Practice Address - Fax:907-258-4435
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK787208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00167867OtherRAILROAD MEDICARE
AKNP0787Medicaid
0000WFBKKMedicare ID - Type UnspecifiedGROUP
AKNP0787Medicaid
AK152859Medicare ID - Type Unspecified