Healthcare Provider Details

I. General information

NPI: 1407293863
Provider Name (Legal Business Name): KRISTINA FLORES APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINA FLORES KRISTINA VITAL

II. Dates (important events)

Enumeration Date: 05/25/2013
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 BROAD ST STE 240
NEWARK NJ
07102-4417
US

IV. Provider business mailing address

18 WYCKOFF AVE STE 202
WALDWICK NJ
07463-1778
US

V. Phone/Fax

Practice location:
  • Phone: 917-409-8596
  • Fax:
Mailing address:
  • Phone: 917-409-8596
  • Fax: 917-258-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00420300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00420300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: