Provider Demographics
NPI:1578727913
Name:ADAM, KRISTINA RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RENEE
Last Name:ADAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:RENEE
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 11982
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1982
Mailing Address - Country:US
Mailing Address - Phone:850-479-1805
Mailing Address - Fax:850-479-1829
Practice Address - Street 1:5149 N 9TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8734
Practice Address - Country:US
Practice Address - Phone:850-479-1805
Practice Address - Fax:850-479-1829
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07325363A00000X
FLPA9104605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2878423Medicaid
TXTXB131915Medicare PIN