Healthcare Provider Details

I. General information

NPI: 1679309009
Provider Name (Legal Business Name): KRESHA YNES JAMIR BULFANGO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 N ORANGE BLOSSOM TRL
KISSIMMEE FL
34744-2316
US

IV. Provider business mailing address

566 WESTCHESTER CT
DAVENPORT FL
33837-4612
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-4343
  • Fax:
Mailing address:
  • Phone: 863-447-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11035063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: