Provider Demographics
NPI:1427711423
Name:AGRESTA, KRISTY (MSN, APN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:AGRESTA
Suffix:
Gender:F
Credentials:MSN, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1737
Mailing Address - Country:US
Mailing Address - Phone:201-403-4635
Mailing Address - Fax:
Practice Address - Street 1:1135 MAIN AVE # 2C
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2353
Practice Address - Country:US
Practice Address - Phone:973-233-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01215900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily