Provider Demographics
NPI:1306214671
Name:MAZZARELLA, KRISTA (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MAZZARELLA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4141 ABINGTON WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-8812
Mailing Address - Country:US
Mailing Address - Phone:941-219-9517
Mailing Address - Fax:
Practice Address - Street 1:4141 ABINGTON WOODS CIR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-8812
Practice Address - Country:US
Practice Address - Phone:941-219-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9309994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily