Provider Demographics
NPI:1194297275
Name:SISMILICH, KRISTEN MARY (APRN)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MARY
Last Name:SISMILICH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N ROME AVE UNIT 1412
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1266
Mailing Address - Country:US
Mailing Address - Phone:813-362-9681
Mailing Address - Fax:
Practice Address - Street 1:400 N ROME AVE UNIT 1412
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1266
Practice Address - Country:US
Practice Address - Phone:813-362-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9376759163W00000X
FLAPRN11000720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse