Provider Demographics
NPI:1407293863
Name:FLORES, KRISTINA (APN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KRISTINA VITAL
Mailing Address - Street 1:1425 BLOOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5505
Mailing Address - Country:US
Mailing Address - Phone:201-293-0976
Mailing Address - Fax:201-293-0977
Practice Address - Street 1:55 HATCHETTS HILL RD
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1534
Practice Address - Country:US
Practice Address - Phone:800-370-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-25
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00420300363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health