Provider Demographics
NPI:1245947563
Name:WHITCOMB, KURSTIN NICOLE
Entity type:Individual
Prefix:
First Name:KURSTIN
Middle Name:NICOLE
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10422 JEAN LAFFITE AVE
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-8394
Mailing Address - Country:US
Mailing Address - Phone:813-786-7332
Mailing Address - Fax:
Practice Address - Street 1:10422 JEAN LAFFITE AVE
Practice Address - Street 2:
Practice Address - City:THONOTOSASSA
Practice Address - State:FL
Practice Address - Zip Code:33592
Practice Address - Country:US
Practice Address - Phone:813-786-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-253671106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician