Provider Demographics
NPI:1093947285
Name:HERRITAGE, KRISTIN VARELL (FNP, BC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:VARELL
Last Name:HERRITAGE
Suffix:
Gender:F
Credentials:FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4211
Mailing Address - Fax:615-425-4211
Practice Address - Street 1:28312 LEWES GEORGETOWN HWY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3115
Practice Address - Country:US
Practice Address - Phone:302-684-0990
Practice Address - Fax:302-684-0991
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily