Provider Demographics
NPI:1831142330
Name:RYNN, KRISTINE ANN (PA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:RYNN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 ELKCAM BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2626
Mailing Address - Country:US
Mailing Address - Phone:386-532-8200
Mailing Address - Fax:386-774-6862
Practice Address - Street 1:734 ELKCAM BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-2626
Practice Address - Country:US
Practice Address - Phone:386-532-8200
Practice Address - Fax:386-774-6862
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101505207P00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00331050OtherRAILROAD MEDICARE - FLAGL
FLP00331050OtherRAILROAD MEDICARE - FLAGL
FLE6828XMedicare PIN