Healthcare Provider Details

I. General information

NPI: 1831952639
Provider Name (Legal Business Name): CRISTY ANNE ROSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 TURKEY LAKE RD STE 114
ORLANDO FL
32819-8015
US

IV. Provider business mailing address

9430 TURKEY LAKE RD STE 114
ORLANDO FL
32819-8015
US

V. Phone/Fax

Practice location:
  • Phone: 407-354-1202
  • Fax: 407-351-8801
Mailing address:
  • Phone: 407-354-1202
  • Fax: 407-351-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030974
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11030974
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11030974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: