Provider Demographics
NPI:1205246618
Name:ST.HUBERT, KISLENE (ARNP)
Entity type:Individual
Prefix:
First Name:KISLENE
Middle Name:
Last Name:ST.HUBERT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KISLENE
Other - Middle Name:
Other - Last Name:ST. HUBERT-JEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4930 E LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5003
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-330-5074
Practice Address - Street 1:6101 LAKE ELLENOR DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4616
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-956-4675
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3101122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011164900Medicaid
FLARNP3101122OtherSTATE LICENSE
FL011164900Medicaid