Provider Demographics
NPI:1790174399
Name:FEDORA, CRISTA MARIE (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:MARIE
Last Name:FEDORA
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 25TH AVE N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1515
Mailing Address - Country:US
Mailing Address - Phone:615-610-3900
Mailing Address - Fax:
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 720
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-610-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19446363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics