Healthcare Provider Details

I. General information

NPI: 1699431411
Provider Name (Legal Business Name): KRISTIE GREENE, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 S TUTTLE AVE STE 1A
SARASOTA FL
34239-3132
US

IV. Provider business mailing address

1617 S TUTTLE AVE STE 1A
SARASOTA FL
34239-3132
US

V. Phone/Fax

Practice location:
  • Phone: 941-799-5753
  • Fax: 888-814-0877
Mailing address:
  • Phone: 941-799-5753
  • Fax: 888-814-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTIE GREENE
Title or Position: OWNER
Credential: MD
Phone: 941-799-5753