Individual provider · Type 1 NPI
Kristti Lei Birondo Tan, AGNP-BC
Gerontology Nurse Practitioner · Douglasville, GA
NPI number
1679175236
Active
Practice location
4645 Timber Ridge Dr Ste 100
Douglasville, GA 30135-7542
Mailing address
3320 Perimeter Hill Dr
Nashville, TN 37211-4123
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 1014530 (TX) |
| Gerontology Nurse Practitioner Primary | 363LG0600X | 32408 (TN) |
| Adult Health Nurse Practitioner | 363LA2200X | 309683 (NY) |
Gerontology Nurse Practitioner: Definition to come...
Another provider at this address
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About NPI 1679175236
Kristti Lei Birondo Tan, AGNP-BC's National Provider Identifier is 1679175236, issued on Nov 9, 2020. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Douglasville, GA. The record was last updated on Apr 16, 2026.