Provider Demographics
NPI:1184420135
Name:PEREZ, KRISTA REBECCA (APRN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:REBECCA
Last Name:PEREZ
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:WILLIAMS-BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9505 AXIS WAY APT 308
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6006
Mailing Address - Country:US
Mailing Address - Phone:850-902-4411
Mailing Address - Fax:
Practice Address - Street 1:8400 RED BUG LAKE RD STE 2080
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6835
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037827363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health