Healthcare Provider Details

I. General information

NPI: 1669133005
Provider Name (Legal Business Name): KRISTEN ELLEN WATSON APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN ELLEN THOMPSON APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E BRANDON BLVD
BRANDON FL
33511-5219
US

IV. Provider business mailing address

1 N DALE MABRY HWY STE 100
TAMPA FL
33609-2764
US

V. Phone/Fax

Practice location:
  • Phone: 813-278-8293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11017377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: