MEDICARE: MRS. KRISTIN A. WHITE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11006332	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ICJY1	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922443332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN A. WHITE NP

Provider Business Mailing Address
First Line	:	PO BOX 26067
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84126-0067
Country	:	US
Telephone Number	:	239-624-0400
Fax Number	:	239-624-0401

Provider Business Practice Location Address
First Line	:	1875 VETERANS PARK DR STE 2203
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0596
Country	:	US
Telephone Number	:	239-431-5884
Fax Number	:	239-631-6907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	01/15/2025

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