Healthcare Provider Details

I. General information

NPI: 1578722609
Provider Name (Legal Business Name): JENNIFER WINFREE HULTZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HUXLEY RD STE 102
KNOXVILLE TN
37922-3188
US

IV. Provider business mailing address

120 HUXLEY RD STE 102
KNOXVILLE TN
37922-3188
US

V. Phone/Fax

Practice location:
  • Phone: 865-392-6262
  • Fax:
Mailing address:
  • Phone: 865-392-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14028
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: