Provider Demographics
NPI:1548058878
Name:PERNA, KRISTIN MICHELLE (PMHNP)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:PERNA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 RIPPLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-6412
Mailing Address - Country:US
Mailing Address - Phone:813-610-5354
Mailing Address - Fax:
Practice Address - Street 1:262 CRYSTAL GROVE BLVD FL 33548
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-6460
Practice Address - Country:US
Practice Address - Phone:813-279-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11039101363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health