Provider Demographics
NPI:1255678306
Name:DZINGLE, KRISTI NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:NICOLE
Last Name:DZINGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:NICOLE
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2100 RAYBROOK ST SE STE 100B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5782
Mailing Address - Country:US
Mailing Address - Phone:616-320-0096
Mailing Address - Fax:616-320-0097
Practice Address - Street 1:801 BROADWAY AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4462
Practice Address - Country:US
Practice Address - Phone:616-685-7510
Practice Address - Fax:616-685-7511
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant