Healthcare Provider Details

I. General information

NPI: 1407788086
Provider Name (Legal Business Name): KRISTAL ANN ROSENTHAL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14245 NATURES RESERVE DR
LITHIA FL
33547-4340
US

IV. Provider business mailing address

14245 NATURES RESERVE DR
LITHIA FL
33547-4340
US

V. Phone/Fax

Practice location:
  • Phone: 410-900-2187
  • Fax:
Mailing address:
  • Phone: 410-900-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN9559779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: