Provider Demographics
NPI:1538163332
Name:POLECRITTI, KRISTIEN FOX (DO)
Entity type:Individual
Prefix:
First Name:KRISTIEN
Middle Name:FOX
Last Name:POLECRITTI
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 1:3037 LANDOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-7260
Mailing Address - Country:US
Mailing Address - Phone:352-530-5913
Mailing Address - Fax:352-835-7165
Practice Address - Street 1:3037 LANDOVER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-7260
Practice Address - Country:US
Practice Address - Phone:352-530-5913
Practice Address - Fax:352-835-7165
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012943207Q00000X
FLOS11171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI20358Medicare UPIN
PA085009Q9CMedicare ID - Type Unspecified