Provider Demographics
NPI:1942502786
Name:SMITH, KRISTINA (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SMITH
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 1:502 E HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2742
Mailing Address - Country:US
Mailing Address - Phone:850-683-1100
Mailing Address - Fax:850-683-0599
Practice Address - Street 1:502 E HICKORY AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2742
Practice Address - Country:US
Practice Address - Phone:850-683-1100
Practice Address - Fax:850-683-0599
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-108545163W00000X, 363LF0000X
FL11002474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse