Healthcare Provider Details

I. General information

NPI: 1497767917
Provider Name (Legal Business Name): KRISTINE M. REDNOUR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 APOLLO BEACH BLVD
APOLLO BEACH FL
33572-2261
US

IV. Provider business mailing address

282 APOLLO BEACH BLVD
APOLLO BEACH FL
33572-2261
US

V. Phone/Fax

Practice location:
  • Phone: 813-645-4068
  • Fax: 813-645-0312
Mailing address:
  • Phone: 813-645-4068
  • Fax: 813-645-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: