Healthcare Provider Details

I. General information

NPI: 1447422712
Provider Name (Legal Business Name): CRISTINA M BURKS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD 712
HERMITAGE TN
37076-2061
US

IV. Provider business mailing address

1052 STONEHOLLOW WAY
MOUNT JULIET TN
37122-4571
US

V. Phone/Fax

Practice location:
  • Phone: 615-872-9966
  • Fax: 615-872-9967
Mailing address:
  • Phone: 615-872-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000012864
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: