Provider Demographics
NPI:1023494275
Name:PRESCOTT, KRISTEN (APRN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:232 SEAMIST CT
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4039
Mailing Address - Country:US
Mailing Address - Phone:812-525-9685
Mailing Address - Fax:
Practice Address - Street 1:6484 FORT CAROLINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2042
Practice Address - Country:US
Practice Address - Phone:904-745-3618
Practice Address - Fax:904-722-4271
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112707700Medicaid
FLOF065OtherMEDICARE