Provider Demographics
NPI:1831142330
Name:RYNN, KRISTINE ANN (PA)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:RYNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SAINT JOHNS MEDICAL PK DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5299
Mailing Address - Country:US
Mailing Address - Phone:904-794-5411
Mailing Address - Fax:
Practice Address - Street 1:16 SAINT JOHNS MEDICAL PK DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5299
Practice Address - Country:US
Practice Address - Phone:904-794-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101505207P00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00331050OtherRAILROAD MEDICARE - FLAGL
FLP00331050OtherRAILROAD MEDICARE - FLAGL
FLE6828XMedicare PIN