Provider Demographics
NPI:1609189877
Name:STAMOOLIS, CHRISTINA EVYENIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:EVYENIA
Last Name:STAMOOLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5332 AVION PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1412
Mailing Address - Country:US
Mailing Address - Phone:813-851-5050
Mailing Address - Fax:813-738-0508
Practice Address - Street 1:5332 AVION PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1412
Practice Address - Country:US
Practice Address - Phone:813-851-5050
Practice Address - Fax:813-738-0508
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003932700Medicaid
FLP01137685OtherRAILROAD MEDICARE PROVIDER NUMBER
FLEP740YMedicare PIN
FLEP740XMedicare PIN