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General NPI Number Information
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NPI Number | 1326719196
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Entity Type | Individual
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Provider Name | KRISTINA KININMONTH PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 2919 W SWANN AVE STE 404
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City | TAMPA
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State | FL
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Zip | 33609-4052
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Country | US
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Telephone | 813-773-0579
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Fax | 941-253-3401
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Provider Business Mailing Address
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Address Line | 4027 CONDOR LN
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City | SARASOTA
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State | FL
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Zip | 34232-4915
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Country | US
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Telephone | 847-542-9003
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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 | PA9115001
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License Number State | FL
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