Healthcare Provider Details

I. General information

NPI: 1144518630
Provider Name (Legal Business Name): KRISTIN MARIE OLIVER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 202B
ST AUGUSTINE FL
32080-3112
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 202B
ST AUGUSTINE FL
32080-3112
US

V. Phone/Fax

Practice location:
  • Phone: 407-851-5121
  • Fax: 407-851-0439
Mailing address:
  • Phone: 407-851-5121
  • Fax: 407-851-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11025747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: