Healthcare Provider Details

I. General information

NPI: 1053032995
Provider Name (Legal Business Name): KRISTEN TAYLOR RAINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N WICKHAM RD
MELBOURNE FL
32935-2363
US

IV. Provider business mailing address

2346 RAMSEY RD SE
PALM BAY FL
32909-6223
US

V. Phone/Fax

Practice location:
  • Phone: 321-775-3334
  • Fax:
Mailing address:
  • Phone: 860-559-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11021636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: