Individual
KRYSTLE IVANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-PMHNP- BC
Contact information
Practice address
225 E LEMON ST STE 105, LAKELAND, FL 33801-4632
(863) 732-7200
Mailing address
225 E LEMON ST STE 105, LAKELAND, FL 33801-4632
(863) 732-7200
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11037342
FL
Other
Enumeration date
02/04/2025
Last updated
02/13/2025
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