Provider Demographics
NPI:1497767917
Name:REDNOUR, KRISTINE M (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:REDNOUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 APOLLO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2261
Mailing Address - Country:US
Mailing Address - Phone:813-645-4068
Mailing Address - Fax:813-645-0312
Practice Address - Street 1:282 APOLLO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2261
Practice Address - Country:US
Practice Address - Phone:813-645-4068
Practice Address - Fax:813-645-0312
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110106363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00924300OtherRAILROAD MEDICARE PTAN
IN339250A2Medicare PIN
Q25230Medicare UPIN
INP00924300OtherRAILROAD MEDICARE PTAN