Provider Demographics
NPI:1902227085
Name:BROWN, KRISTINA M (BA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3771 SAN JOSE PL STE 22
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2439
Mailing Address - Country:US
Mailing Address - Phone:904-928-0112
Mailing Address - Fax:904-928-0112
Practice Address - Street 1:3771 SAN JOSE PL STE 22
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2439
Practice Address - Country:US
Practice Address - Phone:904-928-0112
Practice Address - Fax:904-928-0112
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist