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General NPI Number Information
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NPI Number | 1598743593
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Entity Type | Individual
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Provider Name | KRISTINA DAWN MULLINS PA C
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Gender | Female
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 14827 SOARING EAGLE CT
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City | FORT MYERS
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State | FL
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Zip | 33912-1827
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Country | US
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Telephone | 304-881-6417
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Fax |
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Provider Business Mailing Address
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Address Line | 14827 SOARING EAGLE CT
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City | FORT MYERS
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State | FL
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Zip | 33912-1827
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Country | US
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Telephone | 304-881-6417
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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 | 00830
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50-002366
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0010-00891
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License Number State | NC
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