Healthcare Provider Details

I. General information

NPI: 1104692367
Provider Name (Legal Business Name): KRISTINA L GANDHARRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

IV. Provider business mailing address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-2810
  • Fax: 321-843-6330
Mailing address:
  • Phone: 321-843-2810
  • Fax: 321-843-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11029913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: