Provider Demographics
NPI:1316304660
Name:ROFF, KRISTEN ALEXANDRIA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ALEXANDRIA
Last Name:ROFF
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ALEXANDRIA
Other - Last Name:SCHNITTKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:6559 N WICKHAM RD STE C-105
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2052
Practice Address - Country:US
Practice Address - Phone:321-395-3298
Practice Address - Fax:321-241-1161
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025197363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO477452YPPWMedicare PIN