Provider Demographics
NPI:1790364081
Name:OENBRINK, KRISTIAN R (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIAN
Middle Name:R
Last Name:OENBRINK
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:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-1147
Mailing Address - Country:US
Mailing Address - Phone:850-371-9932
Mailing Address - Fax:850-271-4113
Practice Address - Street 1:1000 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-2356
Practice Address - Country:US
Practice Address - Phone:850-371-9932
Practice Address - Fax:850-271-4113
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine