Provider Demographics
NPI:1861466492
Name:KRISTOL, MARIELLEN L (AP)
Entity Type:Individual
Prefix:DR
First Name:MARIELLEN
Middle Name:L
Last Name:KRISTOL
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2001
Mailing Address - Country:US
Mailing Address - Phone:904-739-5808
Mailing Address - Fax:904-739-2528
Practice Address - Street 1:2427 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2001
Practice Address - Country:US
Practice Address - Phone:904-739-5808
Practice Address - Fax:904-739-2528
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP0001131171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist