Provider Demographics
NPI:1699044750
Name:ESCOBAR, KRISTIN TATUM (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:TATUM
Last Name:ESCOBAR
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 1:305 BROOKHAVEN AVE NE
Mailing Address - Street 2:APARTMENT 441
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3253
Mailing Address - Country:US
Mailing Address - Phone:561-252-2221
Mailing Address - Fax:
Practice Address - Street 1:305 BROOKHAVEN AVE NE
Practice Address - Street 2:APARTMENT 441
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-3253
Practice Address - Country:US
Practice Address - Phone:561-252-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN182484163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse