Individual
KRISTA JANE GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
701 6TH ST S, ST PETERSBURG, FL 33701-4814
(727) 823-1234
Mailing address
PO BOX 10030, DAYTONA BEACH, FL 32120-0030
(386) 274-7800
(386) 274-7801
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME98049
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15133
BC FLORIDA
FL
05
—
278712100
—
FL
Enumeration date
04/25/2007
Last updated
08/03/2009
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