Active NPI
Bruce Ivan Kristol, PH.D.
- Clinical Psychologist
- Jacksonville, FL
National Provider Identifier
1922091198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY2363
- Practice address
- 2427 University Blvd W
Jacksonville, FL 32217-2001 - Phone
- (904) 738-5808
- Fax
- (904) 739-2528
- NPI assigned
- Aug 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY2363 | FL | Primary |
Addresses
Primary practice location
2427 University Blvd W
Jacksonville, FL 32217-2001
Mailing address
7243 San Jose Blvd
Jacksonville, FL 32217-3425
Phone (904) 739-5808
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY2363 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224115200000",
"number": "1922091198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7243 SAN JOSE BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322173425",
"telephone_number": "904-739-5808",
"fax_number": "904-739-2528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2427 UNIVERSITY BLVD W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322172001",
"telephone_number": "904-738-5808",
"fax_number": "904-739-2528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISTOL",
"first_name": "BRUCE",
"middle_name": "IVAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-23",
"last_updated": "2008-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY2363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.