Healthcare Provider Details

I. General information

NPI: 1104751171
Provider Name (Legal Business Name): KRISTI LEE CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD
LUTZ FL
33558-8005
US

IV. Provider business mailing address

1011 E CUMBERLAND AVE UNIT 1806
TAMPA FL
33602-4273
US

V. Phone/Fax

Practice location:
  • Phone: 813-443-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA1210
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: