Provider Demographics
NPI:1255954228
Name:HANLEY, CRISTINA IRENE (APRN)
Entity type:Individual
Prefix:MS
First Name:CRISTINA
Middle Name:IRENE
Last Name:HANLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:IRENE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-1268
Mailing Address - Country:US
Mailing Address - Phone:386-259-8803
Mailing Address - Fax:386-213-9981
Practice Address - Street 1:PO BOX 1268
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32170-1268
Practice Address - Country:US
Practice Address - Phone:386-259-8803
Practice Address - Fax:386-213-9981
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005698207R00000X, 208VP0014X
FL11005698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202248493Medicaid