Healthcare Provider Details

I. General information

NPI: 1821728676
Provider Name (Legal Business Name): KRISTY IP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S HIAWASSEE RD STE 203
ORLANDO FL
32835-6317
US

IV. Provider business mailing address

3375 AZOLLA ST
ORLANDO FL
32808-3914
US

V. Phone/Fax

Practice location:
  • Phone: 407-286-4031
  • Fax:
Mailing address:
  • Phone: 561-427-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-218981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: