Individual provider Active NPI

Kristina Mabel Nieves Quinones, MD

  • General Practice Physician
  • Riverview, FL
National Provider Identifier
1053038836
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN1597 Issued in FL
Practice address
9088 Progress Blvd
Riverview, FL 33578-4886
Phone
(813) 444-0220
Fax
(813) 367-1961
NPI assigned
Oct 24, 2022
Last updated
Feb 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X ACN1597 FL Primary

Addresses

Primary practice location

9088 Progress Blvd
Riverview, FL 33578-4886

Mailing address

6100 Blue Lagoon Dr Ste 365
Miami, FL 33126-7010
Phone (786) 322-7333

Other identifiers 2

IdentifierTypeStateIssuer
ACN1597OtherFLMEDICAL LICENSE
16125-IOtherJUNTA DE LICENCIAMIENTO Y DISCIPLINA MEDICA DE PUERTO RICO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240226003295 FL Practitioner - General Practice 9133563190 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ACN1597FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ayala Troche, MD, C.S.P. PastSince Oct 1, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1053038836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 BLUE LAGOON DR STE 365",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331267010",
            "telephone_number": "786-322-7333",
            "fax_number": "786-322-7329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9088 PROGRESS BLVD",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335784886",
            "telephone_number": "813-444-0220",
            "fax_number": "813-367-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEVES QUINONES",
        "first_name": "KRISTINA",
        "middle_name": "MABEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-24",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ACN1597",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JUNTA DE LICENCIAMIENTO Y DISCIPLINA MEDICA DE PUERTO RICO",
            "identifier": "16125-I",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverview, FL

Sources for this page

Verify at the official NPI Registry.