Provider Demographics
NPI:1871596023
Name:KRONSNOBLE, KRISTIN M (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:M
Last Name:KRONSNOBLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-251-8017
Mailing Address - Fax:813-251-0096
Practice Address - Street 1:409 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2707
Practice Address - Country:US
Practice Address - Phone:813-251-8017
Practice Address - Fax:813-251-0096
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5454103TC0700X, 103TH0100X, 103T00000X
GAPSY002071103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL212084400Medicaid
FL59879YMedicare ID - Type Unspecified
FL212084400Medicaid