Provider Demographics
NPI:1346902335
Name:SHENKMAN, KRISTA (APRN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:SHENKMAN
Suffix:
Gender:F
Credentials:APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MANDALAY AVE APT 53
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767-1717
Mailing Address - Country:US
Mailing Address - Phone:813-817-7295
Mailing Address - Fax:
Practice Address - Street 1:501 S LINCOLN AVE STE 22
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5964
Practice Address - Country:US
Practice Address - Phone:727-357-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015670363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology