Provider Demographics
NPI:1053572529
Name:LINARES, KRISTA (LMT)
Entity type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:
Last Name:LINARES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 KESWICK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1875
Mailing Address - Country:US
Mailing Address - Phone:904-377-8910
Mailing Address - Fax:
Practice Address - Street 1:1785 KESWICK RD
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1875
Practice Address - Country:US
Practice Address - Phone:904-377-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist