Provider Demographics
NPI:1417284878
Name:SCALZITTI, KRISTINA LAUREN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LAUREN
Last Name:SCALZITTI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:3500 FRANCISCAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-0033
Practice Address - Country:US
Practice Address - Phone:219-861-5539
Practice Address - Fax:219-861-5725
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71003111A363L00000X, 363LF0000X
IN28160519A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN363257151OtherTIN NUMBER