Provider Demographics
NPI:1063783272
Name:BORCHETTA, KRISTEN M (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:M
Last Name:BORCHETTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24006 SW 115TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3160
Mailing Address - Country:US
Mailing Address - Phone:561-301-1072
Mailing Address - Fax:
Practice Address - Street 1:246 OAKHURST CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4752
Practice Address - Country:US
Practice Address - Phone:609-964-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11986208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010766200Medicaid