Healthcare Provider Details

I. General information

NPI: 1265778310
Provider Name (Legal Business Name): KRISTEN MARIE BATT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MARIE DEANGELI RPA-C

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4861 27TH ST W
BRADENTON FL
34207-1726
US

IV. Provider business mailing address

12240 TRAILHEAD DR
BRADENTON FL
34211-3606
US

V. Phone/Fax

Practice location:
  • Phone: 941-755-0800
  • Fax:
Mailing address:
  • Phone: 941-400-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA9117475
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: