Provider Demographics
NPI:1336468842
Name:ALLISON, KRISTIN GRIMM (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:GRIMM
Last Name:ALLISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:JENNIFER
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3901 UNIVERSITY BLVD S STE 221
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4392
Mailing Address - Country:US
Mailing Address - Phone:904-423-0010
Mailing Address - Fax:904-423-0012
Practice Address - Street 1:3901 UNIVERSITY BLVD S STE 221
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4392
Practice Address - Country:US
Practice Address - Phone:904-423-0010
Practice Address - Fax:904-423-0012
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
PAMA056298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00934242OtherRR MEDICARE
VAP00934242OtherRR MEDICARE