Healthcare Provider Details

I. General information

NPI: 1093645970
Provider Name (Legal Business Name): KRISTIN M HEROLD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN M ALLAN APRN

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHERIDAN RD
MELBOURNE FL
32901-3184
US

IV. Provider business mailing address

400 SHERIDAN RD
MELBOURNE FL
32901-3184
US

V. Phone/Fax

Practice location:
  • Phone: 321-722-5200
  • Fax:
Mailing address:
  • Phone: 321-722-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11047634
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: