Provider Demographics
NPI:1235192428
Name:ROSENBERG, KRISTA D
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:D
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 N FEDERAL HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1907
Mailing Address - Country:US
Mailing Address - Phone:954-776-6880
Mailing Address - Fax:954-229-3100
Practice Address - Street 1:6333 N FEDERAL HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1907
Practice Address - Country:US
Practice Address - Phone:954-776-6880
Practice Address - Fax:954-229-3100
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90178207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270178200Medicaid
FL48054OtherBCBSFL
FL48054OtherBCBSFL
FLI12861Medicare UPIN