Provider Demographics
NPI:1639628670
Name:GARAVAGLIA, KRISTINA NICCOLE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:NICCOLE
Last Name:GARAVAGLIA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:KRISTINA
Other - Middle Name:NICCOLE
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746723
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6723
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:11260 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3320
Practice Address - Country:US
Practice Address - Phone:313-749-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9321512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily