Provider Demographics
NPI:1578722609
Name:HULTZ, JENNIFER WINFREE (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WINFREE
Last Name:HULTZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HUXLEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3188
Mailing Address - Country:US
Mailing Address - Phone:865-392-6262
Mailing Address - Fax:
Practice Address - Street 1:120 HUXLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3188
Practice Address - Country:US
Practice Address - Phone:865-392-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14028367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3604825Medicare PIN