Healthcare Provider Details

I. General information

NPI: 1699604553
Provider Name (Legal Business Name): KRISTEN ELIZABETH PRINGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 W STATE ROAD 434 STE 108
LONGWOOD FL
32750-4953
US

IV. Provider business mailing address

13376 HIGHLAND CHASE PL
FORT MYERS FL
33913-7804
US

V. Phone/Fax

Practice location:
  • Phone: 407-324-7772
  • Fax: 321-248-0717
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-505349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: