Provider Demographics
NPI:1629552351
Name:LAURELLA, KRISTEN LEIGH (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEIGH
Last Name:LAURELLA
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4171
Mailing Address - Country:US
Mailing Address - Phone:321-427-2447
Mailing Address - Fax:
Practice Address - Street 1:1954 US HIGHWAY 1 STE 115
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3761
Practice Address - Country:US
Practice Address - Phone:321-338-7373
Practice Address - Fax:321-631-8545
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9424368163WG0000X
FLARNP9303071207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily