1437162849 NPI number — KRISTEN J CIRILLO PA-C

Table of content: KRISTEN J CIRILLO PA-C (NPI 1437162849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437162849 NPI number — KRISTEN J CIRILLO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIRILLO
Provider First Name:
KRISTEN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437162849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13805 FOLKSTONE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-7704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-791-3752
Provider Business Mailing Address Fax Number:
561-204-3621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13005 SOUTHERN BLVD STE 142
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOXAHATCHEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33470-9231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-204-3620
Provider Business Practice Location Address Fax Number:
561-204-3621
Provider Enumeration Date:
08/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA0002623 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA0002623 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 290559100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".