Healthcare Provider Details

I. General information

NPI: 1912714338
Provider Name (Legal Business Name): KRISTI GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N HABANA AVE
TAMPA FL
33614-7160
US

IV. Provider business mailing address

804 E NORTH BAY ST
TAMPA FL
33603-4328
US

V. Phone/Fax

Practice location:
  • Phone: 888-666-3089
  • Fax:
Mailing address:
  • Phone: 813-503-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: