Provider Demographics
NPI:1114574548
Name:NORTH, KRISTINA MELISSA (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MELISSA
Last Name:NORTH
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 1:10321 124TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-6958
Mailing Address - Country:US
Mailing Address - Phone:386-688-2880
Mailing Address - Fax:
Practice Address - Street 1:1100 11TH ST SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3608
Practice Address - Country:US
Practice Address - Phone:386-362-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily