Provider Demographics
NPI:1659857530
Name:PENA, KRISTINA (ARNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:704 W AVENIDA DEL RIO
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-2315
Mailing Address - Country:US
Mailing Address - Phone:863-228-4536
Mailing Address - Fax:
Practice Address - Street 1:115 S GLORIA ST
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3505
Practice Address - Country:US
Practice Address - Phone:863-983-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9394335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily