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1962716803 NPI number — KRISTI A. PRENDERGAST APRN

NPI Number: 1962716803
Health Care Provider/Practitioner: KRISTI A. PRENDERGAST APRN

Information about “1962716803” NPI (KRISTI A. PRENDERGAST APRN) exists in 1962716803 in HTML format HTML  |  1962716803 in plain Text format TXT  |  1962716803 in PDF (Portable Document Format) PDF  |  1962716803 in an XML format XML  formats.

NPI Number : 1962716803 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962716803",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PRENDERGAST",
    "FirstName": "KRISTI",
    "MiddleName": "A.",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "61 SANDSTONE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ST AUGUSTINE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32086-0279",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "419-304-4555",
    "MailingAddressFaxNumber": "904-656-7477",
    "FirstLinePracticeLocationAddress": "7901 4TH ST N # 29055",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ST PETERSBURG",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33702-4305",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-257-3160",
    "PracticeLocationAddressFaxNumber": "904-656-7477",
    "EnumerationDate": "08/03/2010",
    "LastUpdateDate": "10/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "ARNP9259886",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "1064417",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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