Provider Demographics
NPI:1033711981
Name:DIBARTOLO, KRISTINA M (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:DIBARTOLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 SPRINGVIEW LN # A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8153
Mailing Address - Country:US
Mailing Address - Phone:843-832-9113
Mailing Address - Fax:843-832-9114
Practice Address - Street 1:90 SPRINGVIEW LN # A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8153
Practice Address - Country:US
Practice Address - Phone:843-832-9113
Practice Address - Fax:843-832-9114
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25819363LF0000X
MARN2300900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily