Provider Demographics
NPI:1477185007
Name:WARREN, KRISTY L (MSN-ED,RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:L
Last Name:WARREN
Suffix:
Gender:F
Credentials:MSN-ED,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 FRANCONIA DR
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812-3622
Mailing Address - Country:US
Mailing Address - Phone:321-945-7476
Mailing Address - Fax:
Practice Address - Street 1:6650 FRANCONIA DR
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32812-3622
Practice Address - Country:US
Practice Address - Phone:321-945-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9223970163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse