Provider Demographics
NPI:1144518630
Name:OLIVER, KRISTIN MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S STE 202B
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3112
Mailing Address - Country:US
Mailing Address - Phone:407-851-5121
Mailing Address - Fax:407-851-0439
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 202B
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3112
Practice Address - Country:US
Practice Address - Phone:407-851-5121
Practice Address - Fax:407-851-0439
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025747363LP0808X
PASP004778B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty