Provider Demographics
NPI:1982080453
Name:COOLEY, KRISTINE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 OAKLEAF RUN DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3987
Mailing Address - Country:US
Mailing Address - Phone:800-321-6879
Mailing Address - Fax:833-803-4528
Practice Address - Street 1:548 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5401
Practice Address - Country:US
Practice Address - Phone:800-321-6879
Practice Address - Fax:833-803-4528
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-4364363LF0000X
PASP024100363LF0000X
WY49728363LF0000X
NDR52275363LF0000X
FLARNP9390947363LF0000X
KS53-78941-051363LF0000X
TX1035172363LF0000X
AR124187363LF0000X
IAA157847363LF0000X
IL277000613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015867800Medicaid
FL015867800Medicaid