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General NPI Number Information
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NPI Number | 1518425024
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Entity Type | Individual
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Provider Name | KRISTA RAE SITLER ATC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 3351 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5301
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Country | US
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Telephone | 904-402-4399
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Fax |
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Provider Business Mailing Address
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Address Line | 7632 SOUTHSIDE BLVD APT 383
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7083
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Country | US
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Telephone | 330-814-0595
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL5415
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License Number State | FL
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