Provider Demographics
NPI:1528713641
Name:DURAN, KRISTINA JOANNE (CRDH)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:JOANNE
Last Name:DURAN
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:JOANNE
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3941 MOSSY LIMB CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1258
Mailing Address - Country:US
Mailing Address - Phone:727-710-0576
Mailing Address - Fax:
Practice Address - Street 1:1900 BROTHER GEENEN WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7102
Practice Address - Country:US
Practice Address - Phone:941-529-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH26830124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist