Healthcare Provider Details

I. General information

NPI: 1336680982
Provider Name (Legal Business Name): KRISTIN MIDKIFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 RACE TRACK RD STE 102
ST JOHNS FL
32259-2457
US

IV. Provider business mailing address

3 CENTURY DR
PARSIPPANY NJ
07054-4610
US

V. Phone/Fax

Practice location:
  • Phone: 904-679-3537
  • Fax:
Mailing address:
  • Phone: 734-330-6730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: