MEDICARE: ERIKA JEAN KRISTENSEN MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	25988	FL

General Provider Information

NPI Number	:	1124960612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA JEAN KRISTENSEN MSW, LCSW

Provider Business Mailing Address
First Line	:	1405 PARK AVE STE 201
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-1951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 PARK AVE STE 201
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-1951
Country	:	US
Telephone Number	:	904-895-4780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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