Provider Demographics
NPI:1780346825
Name:HANCOCK, KRISTIN MICHELLE
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:HANCOCK
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 1:4810 W GANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3003
Mailing Address - Country:US
Mailing Address - Phone:813-380-8230
Mailing Address - Fax:813-991-9504
Practice Address - Street 1:4810 W GANDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3003
Practice Address - Country:US
Practice Address - Phone:813-380-8230
Practice Address - Fax:813-991-9504
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician