Healthcare Provider Details

I. General information

NPI: 1184589715
Provider Name (Legal Business Name): KRISTINA SAMONE BOURNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

V. Phone/Fax

Practice location:
  • Phone: 305-562-5999
  • Fax:
Mailing address:
  • Phone: 305-562-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN11042513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: