Healthcare Provider Details

I. General information

NPI: 1164809976
Provider Name (Legal Business Name): KRISTAL GREENQUIST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 MAR WALT DR UNIT 220
FORT WALTON BEACH FL
32547-6661
US

IV. Provider business mailing address

1032 MAR WALT DR UNIT 220
FORT WALTON BEACH FL
32547-6661
US

V. Phone/Fax

Practice location:
  • Phone: 850-374-9610
  • Fax: 850-374-9611
Mailing address:
  • Phone: 850-374-9610
  • Fax: 850-374-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9440783
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9440783
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: