Provider Demographics
NPI:1871832279
Name:HAGER, KRISTINA (MS, IMH 10800)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:HAGER
Suffix:
Gender:F
Credentials:MS, IMH 10800
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9907 MENANDER WOOD CT
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6323 MEMORIAL HWY
Practice Address - Street 2:BUILDING A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4509
Practice Address - Country:US
Practice Address - Phone:813-891-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 10800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health