Provider Demographics
NPI:1952012346
Name:VULGAMORE, KRISTEN (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:VULGAMORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 TAMIAMI TRL UNIT C
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2178
Mailing Address - Country:US
Mailing Address - Phone:941-629-4464
Mailing Address - Fax:
Practice Address - Street 1:2040 TAMIAMI TRL UNIT C
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2178
Practice Address - Country:US
Practice Address - Phone:941-629-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily