Healthcare Provider Details

I. General information

NPI: 1467365635
Provider Name (Legal Business Name): KRISTEN BRIGINO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

3652 GOLDEN EAGLE DR
LAND O LAKES FL
34639-9543
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-4673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9602300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: