Provider Demographics
NPI:1093179228
Name:WHITE, KRISTA (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 17TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3503
Mailing Address - Country:US
Mailing Address - Phone:813-775-9997
Mailing Address - Fax:813-775-9997
Practice Address - Street 1:2020 TOWN CENTER BLVD STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2906
Practice Address - Country:US
Practice Address - Phone:813-315-1500
Practice Address - Fax:813-377-1686
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3388252363LF0000X
FLAPRN3388252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018330100Medicaid
FLIS885Z-TPAMedicare PIN
FLIP003YMedicare PIN