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General NPI Number Information
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NPI Number | 1124210265
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Entity Type | Individual
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Provider Name | KRISTINA LIZETTE REEVES PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 1817 CYPRESS BROOK DR SUITE 101
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City | TRINITY
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State | FL
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Zip | 34655-4416
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Country | US
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Telephone | 727-834-8377
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Fax |
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Provider Business Mailing Address
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Address Line | 5116 W CLEVELAND ST
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City | TAMPA
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State | FL
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Zip | 33609-3504
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Country | US
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Telephone | 813-857-8974
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9104215
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License Number State | FL
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