Healthcare Provider Details

I. General information

NPI: 1093947285
Provider Name (Legal Business Name): KRISTIN VARELL HERRITAGE FNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28312 LEWES GEORGETOWN HWY
MILTON DE
19968-3115
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 302-684-0990
  • Fax: 302-684-0991
Mailing address:
  • Phone: 615-425-4211
  • Fax: 615-425-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0000491
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: