Provider Demographics
NPI:1629519814
Name:HANENIAN, KRISTEN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:HANENIAN
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 1:4905 W LAUREL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-3834
Mailing Address - Country:US
Mailing Address - Phone:813-388-0485
Mailing Address - Fax:
Practice Address - Street 1:4905 W LAUREL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3834
Practice Address - Country:US
Practice Address - Phone:813-388-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9244410363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health