Individual
KRYSTA ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
400 AVENUE F SE FL 1, WINTER HAVEN, FL 33880-3751
(727) 315-6775
Mailing address
2995 DREW ST FL 2, CLEARWATER, FL 33759-3012
(727) 315-7469
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
544669
NY
363LF0000X
Family Nurse Practitioner
APRN11018536
FL
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN11018536
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117903900
—
FL
Enumeration date
07/14/2019
Last updated
07/08/2024
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