Provider Demographics
NPI:1144382623
Name:ILGENFRITZ, KRISTINE ROBERTA (PAC)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:ROBERTA
Last Name:ILGENFRITZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:109 TIMBERLACHEN CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3395
Mailing Address - Country:US
Mailing Address - Phone:407-333-9877
Mailing Address - Fax:407-333-9881
Practice Address - Street 1:109 TIMBERLACHEN CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3395
Practice Address - Country:US
Practice Address - Phone:407-333-9877
Practice Address - Fax:407-333-9881
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100962363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant