Kristine C Hertzog, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9104652 Issued in FL

Practice address

805 Century Medical Dr Ste a
Titusville, FL 32796-2100

Phone

(321) 567-7530

Fax

(321) 225-8723

NPI assigned

Jul 25, 2008

Last updated

Feb 11, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kristine C Poyner Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brevard Medical Dermatology, PAGroup PAC ID 4688999345, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: kristine.hbrevardmd.com@drspicer.emadirect.md
• Direct secure messaging: kristinehertzog@brevardskin.allscriptsdirect.net

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.

• Brevard Medical Dermatology, PA

  • Dermatology Physician
  • Melbourne, FL
  • NPI 1649676669
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1750546040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7725 MILLBROOK AVE",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407812",
            "telephone_number": "407-408-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 CENTURY MEDICAL DR STE A",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962100",
            "telephone_number": "321-567-7530",
            "fax_number": "321-225-8723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERTZOG",
        "first_name": "KRISTINE",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-25",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104652",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9104652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINE",
            "last_name": "POYNER",
            "middle_name": "C",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hendrixs Eye Care, Inc.
• Diane Judith Heribacka, LMFT
• Richard D. Herman, PH.D.
• Angel Len Herndon
• Stephanie Diana Hertz, MSN, APRN, FNP-C
• Melinda Miller Heyne
• Hidden Potentials Inc.
• Sheree Hill, MSW, LCSW
• Dawn Michele Hillebrandt, ARNP
• Karlisia Hinton

• Medical Physician Assistant in Titusville, FL
• Providers in Titusville, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.