Provider Demographics
NPI:1801685003
Name:ROBERTS-LARGE, KRISTINE LYNN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LYNN
Last Name:ROBERTS-LARGE
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 58TH AVE # 318
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-4647
Mailing Address - Country:US
Mailing Address - Phone:772-307-9840
Mailing Address - Fax:
Practice Address - Street 1:6200 20TH ST STE 318
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1079
Practice Address - Country:US
Practice Address - Phone:772-307-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9681677163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1881098416Medicaid