Provider Demographics
NPI:1558712307
Name:SCHULTZ TANNER, KRISTINA (APRN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SCHULTZ TANNER
Suffix:
Gender:F
Credentials:APRN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 GREAT OAK DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-5707
Mailing Address - Country:US
Mailing Address - Phone:706-224-7254
Mailing Address - Fax:706-475-2121
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:STE 700
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1465
Practice Address - Country:US
Practice Address - Phone:706-353-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN157317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003234315AMedicaid