Provider Demographics
NPI:1801403068
Name:SOLIE, KRYSTAL G (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:G
Last Name:SOLIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 MCCORMICK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3019
Mailing Address - Country:US
Mailing Address - Phone:813-381-5672
Mailing Address - Fax:
Practice Address - Street 1:14105 MCCORMICK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3019
Practice Address - Country:US
Practice Address - Phone:813-381-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10580363LF0000X
FL11009188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily