Provider Demographics
NPI:1609052471
Name:GERMANN, KRISTINE SUE (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:SUE
Last Name:GERMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:615-329-2294
Mailing Address - Fax:615-695-1494
Practice Address - Street 1:315 N WASHINGTON AVE STE 150
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2623
Practice Address - Country:US
Practice Address - Phone:931-231-8365
Practice Address - Fax:931-525-6689
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1565363A00000X, 363AM0700X
GA002597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ065668Medicaid
SC1787PAMedicaid
FLY0P4TOtherBCBS FL
GA003195654BMedicaid