Provider Demographics
NPI:1285640805
Name:DAVIS, KRISTEN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:SOLOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8415 BAYSHORE BLVD
Mailing Address - Street 2:6 MEDICAL GROUP
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33621-1607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8415 BAYSHORE BLVD
Practice Address - Street 2:6 MEDICAL GROUP
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-1607
Practice Address - Country:US
Practice Address - Phone:813-827-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292269000Medicaid
FLU6614ZMedicare PIN
FL292269000Medicaid
FLP00294747Medicare PIN