Healthcare Provider Details

I. General information

NPI: 1265192611
Provider Name (Legal Business Name): KRISTY LEE CHINEA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 EXECUTIVE DR
NAPLES FL
34119-9033
US

IV. Provider business mailing address

15118 PALMER LAKE CIR UNIT 101
NAPLES FL
34109-9056
US

V. Phone/Fax

Practice location:
  • Phone: 239-591-2803
  • Fax:
Mailing address:
  • Phone: 239-398-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11017151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: