Provider Demographics
NPI:1033160056
Name:HAMILTON, KRISTY (PHD, MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PHD, MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 MAR BRISA CT
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3067
Mailing Address - Country:US
Mailing Address - Phone:321-726-8192
Mailing Address - Fax:
Practice Address - Street 1:604 MAR BRISA CT
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3067
Practice Address - Country:US
Practice Address - Phone:321-726-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15756363A00000X
FLPA9101419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6261UOtherMEDICARE PTAN