Provider Demographics
NPI:1568473866
Name:PHILLIPS, KRISTIN (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 VILLA DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-5564
Mailing Address - Country:US
Mailing Address - Phone:813-870-4438
Mailing Address - Fax:813-870-4153
Practice Address - Street 1:3003 W MARTIN LUTHER KING BLVD
Practice Address - Street 2:MAB 3RD FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-870-4438
Practice Address - Fax:813-870-4153
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1679932363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP1679932OtherFLORIDA LICENSE #