Healthcare Provider Details

I. General information

NPI: 1174237556
Provider Name (Legal Business Name): KRISTIN BRAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N FEDERAL HWY
LAKE PARK FL
33403-3557
US

IV. Provider business mailing address

509 N FEDERAL HWY
LAKE PARK FL
33403-3557
US

V. Phone/Fax

Practice location:
  • Phone: 561-725-7162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW21075
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: