Provider Demographics
NPI:1114523420
Name:HARSHMAN, KRISTIN NICOLE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICOLE
Last Name:HARSHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:855-963-2100
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:14543 GLOBAL PARKWAY
Practice Address - Street 2:SUITE 110 , 2ND FLOOR
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9446
Practice Address - Country:US
Practice Address - Phone:239-264-7026
Practice Address - Fax:239-567-3679
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110273900Medicaid