Provider Demographics
NPI:1750582003
Name:SMITH, KRISTEN J (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:J
Last Name:SMITH
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 1:3614 W. KENNEDY BOULEVARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2231
Mailing Address - Country:US
Mailing Address - Phone:813-870-2528
Mailing Address - Fax:813-876-1003
Practice Address - Street 1:3614 W KENNEDY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2852
Practice Address - Country:US
Practice Address - Phone:813-870-2528
Practice Address - Fax:813-876-1003
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9234672363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner