Provider Demographics
NPI:1346653037
Name:GATES, KRISTOPHER (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:GATES
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N REO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1013
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-864-4436
Practice Address - Street 1:4726 N HABANA AVE STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7144
Practice Address - Country:US
Practice Address - Phone:813-682-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9183257363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9183257OtherSTATE OF FLORIDA