Provider Demographics
NPI:1467136929
Name:CARLOS, KRISTEN TARA SANDOVAL (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTEN TARA
Middle Name:SANDOVAL
Last Name:CARLOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 N 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5409
Mailing Address - Country:US
Mailing Address - Phone:818-445-7690
Mailing Address - Fax:
Practice Address - Street 1:2335 N 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5409
Practice Address - Country:US
Practice Address - Phone:818-445-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61437831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily