Provider Demographics
NPI:1427652825
Name:KRITIKOS, LISA (AGNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KRITIKOS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 BLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3734
Mailing Address - Country:US
Mailing Address - Phone:510-292-5535
Mailing Address - Fax:
Practice Address - Street 1:675 NELSON RISING LN STE 190
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0003
Practice Address - Country:US
Practice Address - Phone:510-292-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95171868163W00000X
CA95015347363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse