Healthcare Provider Details

I. General information

NPI: 1053572529
Provider Name (Legal Business Name): KRISTA LINARES LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 KESWICK RD
SAINT AUGUSTINE FL
32084-1875
US

IV. Provider business mailing address

1785 KESWICK RD
SAINT AUGUSTINE FL
32084-1875
US

V. Phone/Fax

Practice location:
  • Phone: 904-377-8910
  • Fax:
Mailing address:
  • Phone: 904-377-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number51890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: