Provider Demographics
NPI:1568434496
Name:RANKIN, KRISTA WARE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:WARE
Last Name:RANKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 15349
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-5349
Mailing Address - Country:US
Mailing Address - Phone:850-383-3382
Mailing Address - Fax:
Practice Address - Street 1:1264 METROPOLITAN BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-2536
Practice Address - Country:US
Practice Address - Phone:850-383-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-04
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054928207Q00000X
FLME94999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA784279517BMedicaid
U7183ZMedicare ID - Type Unspecified
GA784279517BMedicaid