Provider Demographics
NPI:1902383110
Name:KEENE-HETH, KRISTINE LIANA (APRN-C)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LIANA
Last Name:KEENE-HETH
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LIANA
Other - Last Name:KEENE-HETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-C LLC
Mailing Address - Street 1:29304 PERILLI PL
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-0008
Mailing Address - Country:US
Mailing Address - Phone:808-343-2358
Mailing Address - Fax:
Practice Address - Street 1:1818 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3770
Practice Address - Country:US
Practice Address - Phone:312-635-0973
Practice Address - Fax:313-635-0050
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAG03180101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner