Individual
KRISTIN LEA HOOD PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
ARNP 9265639
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007190500
—
FL
01
—
Y0E9G
BCBS OF FL
FL
Enumeration date
10/17/2012
Last updated
05/05/2014
Update your record
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