Provider Demographics
NPI:1679175236
Name:TAN, KRISTTI LEI BIRONDO (AGNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTTI LEI
Middle Name:BIRONDO
Last Name:TAN
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 PERIMETER HILL DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4123
Mailing Address - Country:US
Mailing Address - Phone:615-866-9040
Mailing Address - Fax:615-750-5756
Practice Address - Street 1:2004 HAYES ST STE 655
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2656
Practice Address - Country:US
Practice Address - Phone:615-866-9040
Practice Address - Fax:615-750-5756
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309683363LA2200X
TX1014530363LA2200X
TN32408363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ079530Medicaid