Provider Demographics
NPI:1013296938
Name:HRISTOV, KRASIMIR M (CNP)
Entity Type:Individual
Prefix:DR
First Name:KRASIMIR
Middle Name:M
Last Name:HRISTOV
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E COLLEGE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-7570
Mailing Address - Country:US
Mailing Address - Phone:575-623-3155
Mailing Address - Fax:
Practice Address - Street 1:400 E COLLEGE BLVD STE E
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-7570
Practice Address - Country:US
Practice Address - Phone:575-623-3155
Practice Address - Fax:915-587-6324
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03573363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty