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General NPI Number Information
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NPI Number | 1053032995
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Entity Type | Individual
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Provider Name | KRISTEN TAYLOR RAINS NP
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Gender | Female
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 3150 N WICKHAM RD
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City | MELBOURNE
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State | FL
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Zip | 32935-2363
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Country | US
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Telephone | 321-775-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 2346 RAMSEY RD SE
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City | PALM BAY
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State | FL
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Zip | 32909-6223
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Country | US
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Telephone | 860-559-1561
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11021636
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License Number State | FL
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