Healthcare Provider Details

I. General information

NPI: 1124244850
Provider Name (Legal Business Name): TINA FRANCES KUJAWSKI AANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RANDOLPH RD SUITE 906
CHARLOTTE NC
28207-1122
US

IV. Provider business mailing address

1900 RANDOLPH RD SUITE 906
CHARLOTTE NC
28207-1122
US

V. Phone/Fax

Practice location:
  • Phone: 704-347-3447
  • Fax: 704-347-3440
Mailing address:
  • Phone: 704-347-3447
  • Fax: 704-347-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900134
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: