Individual
KRISTINA JEAN FISK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11964 BOYETTE RD, RIVERVIEW, FL 33569-5601
(813) 663-9828
Mailing address
904 WINCHESTER CT, BRANDON, FL 33510-2720
(813) 651-1461
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/29/2010
Last updated
11/29/2010
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