Provider Demographics
NPI:1649404989
Name:FREDENBURG, KRISTIANNA MARIE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIANNA
Middle Name:MARIE
Last Name:FREDENBURG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:KRISTIANNA
Other - Middle Name:MARIE
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:5045 SW 78TH WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7419
Mailing Address - Country:US
Mailing Address - Phone:352-375-3055
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:POB 100275
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL#TRN13520207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014760000Medicaid
FLIE097ZMedicare PIN