Provider Demographics
NPI:1740549112
Name:WILSON, KRISTEN ELIZABETH (ARNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-690-5082
Practice Address - Street 1:705 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2842
Practice Address - Country:US
Practice Address - Phone:352-345-8070
Practice Address - Fax:888-690-5082
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2025-09-18
Deactivation Date:2022-12-01
Deactivation Code:
Reactivation Date:2022-12-08
Provider Licenses
StateLicense IDTaxonomies
FL11023285363LF0000X
FLARNP11023285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP11023285OtherFLORIDA MEDICAL LICENSE