Provider Demographics
NPI:1417631144
Name:SHULTZ, SARAH ALEXANDRIA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ALEXANDRIA
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BREWER ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-4629
Mailing Address - Country:US
Mailing Address - Phone:423-368-6806
Mailing Address - Fax:
Practice Address - Street 1:225 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-4010
Practice Address - Country:US
Practice Address - Phone:423-365-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily