Provider Demographics
NPI:1497493118
Name:KNOTH, KRISTIN ASHLY
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ASHLY
Last Name:KNOTH
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 1:3632 BERRY PATCH LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-6324
Mailing Address - Country:US
Mailing Address - Phone:850-776-5827
Mailing Address - Fax:
Practice Address - Street 1:3632 BERRY PATCH LN
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-6324
Practice Address - Country:US
Practice Address - Phone:850-776-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily