Provider Demographics
NPI:1548019995
Name:DEMAGGIO, KRISTEN MICHELLE (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:DEMAGGIO
Suffix:
Gender:F
Credentials:APRN, FNP-C
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Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-223-3898
Mailing Address - Fax:689-223-3898
Practice Address - Street 1:9857 OLD SAINT AUGUSTINE RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8821
Practice Address - Country:US
Practice Address - Phone:904-861-1900
Practice Address - Fax:904-292-9264
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily