Individual
MISS KRISTIN M. MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPH
Contact information
Practice address
1251 HICKORY ST, MELBOURNE, FL 32901-3221
(321) 434-3420
(321) 434-3423
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-3420
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9111626
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101537200
—
FL
01
—
KM444
MEDICARE HFMG
FL
01
—
KN334
MEDICARE HFPSI
FL
Enumeration date
10/01/2018
Last updated
10/26/2023
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