Provider Demographics
NPI:1992197354
Name:KINSEY, CHRISTINE M (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:KINSEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CYPRESS CREEK RD STE 304
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3522
Mailing Address - Country:US
Mailing Address - Phone:954-491-7758
Mailing Address - Fax:954-938-5339
Practice Address - Street 1:800 E CYPRESS CREEK RD STE 304
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3522
Practice Address - Country:US
Practice Address - Phone:954-491-7758
Practice Address - Fax:954-938-5339
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108526363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIG476XMedicare PIN
FLIG476YMedicare PIN
FLIG476ZMedicare PIN