Healthcare Provider Details

I. General information

NPI: 1700382710
Provider Name (Legal Business Name): KRISTIN WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S OLD DIXIE HWY
JUPITER FL
33458
US

IV. Provider business mailing address

10970 SW 44TH ST
MIAMI FL
33165-4725
US

V. Phone/Fax

Practice location:
  • Phone: 561-263-2234
  • Fax:
Mailing address:
  • Phone: 954-330-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9337290
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9337290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: