Provider Demographics
NPI:1164096541
Name:RISOLA, KRISTINA (CRC, NBC-HWC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:RISOLA
Suffix:
Gender:F
Credentials:CRC, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5486 WAYCROSS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5486 WAYCROSS DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4645
Practice Address - Country:US
Practice Address - Phone:352-942-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date: