Provider Demographics
NPI:1457591927
Name:POWELL, KRISTIN D (APRN)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:D
Last Name:POWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:407-831-6200
Mailing Address - Fax:407-831-1068
Practice Address - Street 1:475 OSCEOLA ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7857
Practice Address - Country:US
Practice Address - Phone:407-831-6200
Practice Address - Fax:407-831-1068
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9190205363LP0200X
FLAPRN9190205363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001814300Medicaid