Provider Demographics
NPI:1407296726
Name:FRESHWATER, KIRSTY (ARNP)
Entity Type:Individual
Prefix:
First Name:KIRSTY
Middle Name:
Last Name:FRESHWATER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 FLETCHER DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-2038
Mailing Address - Country:US
Mailing Address - Phone:352-294-7466
Mailing Address - Fax:352-846-1422
Practice Address - Street 1:280 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-2038
Practice Address - Country:US
Practice Address - Phone:352-294-7466
Practice Address - Fax:352-846-1422
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9329461363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009574000Medicaid
FLHP467YMedicare PIN