Provider Demographics
NPI:1134533458
Name:HARMAN, KRISTIN (LPN)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:HARMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:DIANE
Other - Last Name:HARMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:2101 W HIGHWAY 390
Mailing Address - Street 2:APT 422
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-6502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2711 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1366
Practice Address - Country:US
Practice Address - Phone:850-769-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5195147164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse