Provider Demographics
NPI:1124381371
Name:YENTES, KRISTY D (FNP-BC, NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:D
Last Name:YENTES
Suffix:
Gender:F
Credentials:FNP-BC, NP-C
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C, FNP-BC
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-1100
Mailing Address - Fax:239-343-1101
Practice Address - Street 1:13782 PLANTATION RD STE 201
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4462
Practice Address - Country:US
Practice Address - Phone:239-343-1100
Practice Address - Fax:239-343-1101
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16800363LF0000X
FLAPRN11012887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112383000Medicaid