Clark, Krysta Ann

Clark, Krysta Ann is an individual health care provider with primary practice located at 400 Avenue F Se Fl 1 , Winter Haven FL 33880-3751. She recently has 3 registered licenses in different health care specialties including Nursing Service Providers / General Practice, Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Gerontology is her primary health care specialty. Clark, Krysta Ann can be contacted via phone (727) 315-6775.

Contact Information

Primary practice address
400 Avenue F Se Fl 1 Winter Haven FL 33880-3751
Phone: (727) 315-6775
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / General Practice 163WG0000X 544669 New York
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APRN11018536 Florida
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X APRN11018536 Florida

Profile Details

NPI number 1366094914
LBN Legal business name Clark, Krysta Ann
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2019
Last updated Jul 8th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366094914 NPPES
Florida MEDICAID 117903900

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