Provider Demographics
NPI:1487427449
Name:AYCINENA, KRISTY (CSFA)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:AYCINENA
Suffix:
Gender:F
Credentials:CSFA
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 1604
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-1604
Mailing Address - Country:US
Mailing Address - Phone:678-858-1980
Mailing Address - Fax:
Practice Address - Street 1:2856 WOODBRIAR DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-2890
Practice Address - Country:US
Practice Address - Phone:678-858-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical