Provider Demographics
NPI:1437678695
Name:O'DONNELL, KRISTIN LAUREN (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LAUREN
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:LAUREN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8839 BRYAN DAIRY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1207
Mailing Address - Country:US
Mailing Address - Phone:727-394-5650
Mailing Address - Fax:813-635-7939
Practice Address - Street 1:8839 BRYAN DAIRY RD STE 200
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1207
Practice Address - Country:US
Practice Address - Phone:727-394-5650
Practice Address - Fax:813-635-7939
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77892363LF0000X
FLAPRN11007369363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110510100Medicaid