Healthcare Provider Details

I. General information

NPI: 1396128989
Provider Name (Legal Business Name): KRISTEN MARIE COMBS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOOTH RD STE A
ORMOND BEACH FL
32174-5716
US

IV. Provider business mailing address

303 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2709
US

V. Phone/Fax

Practice location:
  • Phone: 386-523-1212
  • Fax: 386-523-1213
Mailing address:
  • Phone: 386-254-4000
  • Fax: 386-226-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9236482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: