Provider Demographics
NPI:1902460678
Name:CAMERON, KRISTELLE M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTELLE
Middle Name:M
Last Name:CAMERON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTELLE
Other - Middle Name:M
Other - Last Name:GILLIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:603 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4719
Mailing Address - Country:US
Mailing Address - Phone:727-893-6254
Mailing Address - Fax:727-553-7158
Practice Address - Street 1:603 7TH ST S STE 500
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4734
Practice Address - Country:US
Practice Address - Phone:727-893-6254
Practice Address - Fax:727-553-7158
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002432363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner