MEDICARE: KRISTIN L AMBROSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH29281	FL

General Provider Information

NPI Number	:	1245966266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN L AMBROSE

Provider Business Mailing Address
First Line	:	465 MAITLAND AVE
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5444
Country	:	US
Telephone Number	:	877-915-5745
Fax Number	:

Provider Business Practice Location Address
First Line	:	465 MAITLAND AVE
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5444
Country	:	US
Telephone Number	:	877-915-5745
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	05/27/2026

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Directions to “ KRISTIN L AMBROSE ” Practice Location

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