Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kristti Lei Birondo Tan, AGNP-BC

Individual provider Adult Health Nurse Practitioner · NPI 1679175236

Kristti Lei Birondo Tan, AGNP-BC is a Nurse Practitioner in Douglasville, Georgia. Qualified in 2020, 6 years ago. Practices with Douglas Dermatology and Skin Cancer Specialists LLC, a 9-clinician group and accepts Medicare assignment. Licensed in New York, Tennessee and Texas.

Years since qualifying
6
Licensed in
NY, TN, TX
In the registry since
2020
Specialties on file
3

Practice location Address checks out

4645 Timber Ridge Dr Ste 100
Douglasville, GA 30135-7542
Phone: (678) 702-3376
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence 32408 (TN)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence 1014530 (TX)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence 309683 (NY)

Record details

NPI number1679175236
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGNP-BC
Sole proprietorNo
NPI enumeratedNovember 9, 2020
Last updated in NPPESApril 16, 2026
Certification dateApril 16, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Douglas Dermatology And Skin Cancer Specialists Llc — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Douglasville