MEDICARE: KRISTINA MARIE JOSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	ME112827	FL

General Provider Information

NPI Number	:	1679843106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MARIE JOSE M.D.

Provider Business Mailing Address
First Line	:	3000 N ORANGE AVE
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32804-7613
Country	:	US
Telephone Number	:	407-896-9660
Fax Number	:	407-896-9661

Provider Business Practice Location Address
First Line	:	3000 N ORANGE AVE
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32804-7613
Country	:	US
Telephone Number	:	407-896-9660
Fax Number	:	407-896-9661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	07/01/2014

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