Provider Demographics
NPI:1679660567
Name:EVERSOLE, KRISTIN L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:L
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:LYNN
Other - Last Name:STOBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5220 BELFORT RD
Mailing Address - Street 2:STE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:904-446-3451
Mailing Address - Fax:904-446-3013
Practice Address - Street 1:5220 BELFORT RD
Practice Address - Street 2:STE 130
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6017
Practice Address - Country:US
Practice Address - Phone:904-446-3451
Practice Address - Fax:904-446-3013
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2649042163WW0000X, 2083P0011X
FL2649042207RC0000X
FLARNP 2649042207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003127800Medicaid
FLE3924WMedicare UPIN
FLP03893Medicare UPIN
FLE3924YMedicare PIN