Provider Demographics
NPI:1669525234
Name:HART, KRESTANA KAY (ARNP)
Entity type:Individual
Prefix:
First Name:KRESTANA
Middle Name:KAY
Last Name:HART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 BUENOS AIRES BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6823
Mailing Address - Country:US
Mailing Address - Phone:352-750-5882
Mailing Address - Fax:352-750-9947
Practice Address - Street 1:3913 SW 57TH TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:561-315-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2969712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJE518ZOtherMEDICARE
FL1542GOtherEMPIRE BLUE CROSS BLUE SHIELD
FL1542GOtherEMPIRE BLUE CROSS BLUE SHIELD