Provider Demographics
NPI:1376574715
Name:MINNETI, KRISTI L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:MINNETI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 ULMERTON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33762-2283
Mailing Address - Country:US
Mailing Address - Phone:727-471-0324
Mailing Address - Fax:727-471-0329
Practice Address - Street 1:2575 ULMERTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33762-2283
Practice Address - Country:US
Practice Address - Phone:727-471-0324
Practice Address - Fax:727-471-0329
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 859882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL209515Medicaid
FLME 85988OtherFLORIDA MEDICAL LICENSE
FLH42168Medicare UPIN
FL47851Medicare PIN