Healthcare Provider Details

I. General information

NPI: 1477531671
Provider Name (Legal Business Name): KEVIN F. CRONIN SF-IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 8TH AVE SE
ST PETERSBURG USA
33701
UM

IV. Provider business mailing address

600 8TH AVE SE
ST PETERSBURG FL
33701-5030
US

V. Phone/Fax

Practice location:
  • Phone: 727-502-1586
  • Fax:
Mailing address:
  • Phone: 727-502-1586
  • Fax: 727-502-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: