Provider Demographics
NPI:1376234245
Name:NELON, KRISTINA M
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:NELON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9466 NAVARRE PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2948
Mailing Address - Country:US
Mailing Address - Phone:850-865-5238
Mailing Address - Fax:
Practice Address - Street 1:9466 NAVARRE PKWY STE B
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2948
Practice Address - Country:US
Practice Address - Phone:850-865-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty