Healthcare Provider Details

I. General information

NPI: 1144010927
Provider Name (Legal Business Name): KRISTEN LEE SHOTWELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN HENDERSON

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 S ALT A1A STE 420
JUPITER FL
33477-4063
US

IV. Provider business mailing address

4580 SE FEDERAL HWY APT 7410
STUART FL
34997-5783
US

V. Phone/Fax

Practice location:
  • Phone: 561-743-5580
  • Fax:
Mailing address:
  • Phone: 561-222-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11039317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: