Provider Demographics
NPI:1023274727
Name:RISTAU, KIMBERLY SNYDER (ARNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SNYDER
Last Name:RISTAU
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 BAY ISLE CIR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-2959
Mailing Address - Country:US
Mailing Address - Phone:727-422-0856
Mailing Address - Fax:
Practice Address - Street 1:2333 W HILLSBOROUGH AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1059
Practice Address - Country:US
Practice Address - Phone:813-872-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1756262363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBH638ZOtherMEDICARE NUMBER