Healthcare Provider Details

I. General information

NPI: 1417846692
Provider Name (Legal Business Name): KRYSTINA MARIE WOYCHOWSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTINA DESOMMA

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 S WEST SHORE BLVD STE 128 C
TAMPA FL
33609-2439
US

IV. Provider business mailing address

12214 MATISSE CIR UNIT 107
NEW PORT RICHEY FL
34655-4749
US

V. Phone/Fax

Practice location:
  • Phone: 813-358-6814
  • Fax:
Mailing address:
  • Phone: 352-464-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11040398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: