Provider Demographics
NPI:1720355779
Name:SIGNORINI, KRISTINE ANDREA (APRN, MS)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANDREA
Last Name:SIGNORINI
Suffix:
Gender:F
Credentials:APRN, MS
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ANDREA
Other - Last Name:BAMFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:208 CRYSTAL GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-6460
Mailing Address - Country:US
Mailing Address - Phone:813-909-1600
Mailing Address - Fax:813-909-1005
Practice Address - Street 1:208 CRYSTAL GROVE BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-6460
Practice Address - Country:US
Practice Address - Phone:813-949-4991
Practice Address - Fax:813-949-4986
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9242219363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY09UHOtherFLORIDA BLUE
FL009431300Medicaid