Provider Demographics
NPI:1487843520
Name:GREENE, KRISTIE A (MD)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:A
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 S TUTTLE AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3132
Mailing Address - Country:US
Mailing Address - Phone:941-799-5753
Mailing Address - Fax:888-814-0877
Practice Address - Street 1:1617 S TUTTLE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3132
Practice Address - Country:US
Practice Address - Phone:941-799-5753
Practice Address - Fax:888-814-0877
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106607207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018894600Medicaid
FL4034MOtherFL BLUE CROSS
FLIT663ZMedicare PIN