Provider Demographics
NPI:1669954335
Name:PORTELL, KRYSTYNA LEE (FNP)
Entity type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:LEE
Last Name:PORTELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 TILMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-6337
Mailing Address - Country:US
Mailing Address - Phone:434-242-6178
Mailing Address - Fax:
Practice Address - Street 1:1450 SACHEM PL UNIT 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2554
Practice Address - Country:US
Practice Address - Phone:434-973-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175928363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner