Provider Demographics
NPI:1386717155
Name:HAFNER, KRISTEN M (PA)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:M
Last Name:HAFNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7784 GREAT OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7109
Mailing Address - Country:US
Mailing Address - Phone:561-357-5636
Mailing Address - Fax:561-357-7452
Practice Address - Street 1:3400 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5815
Practice Address - Country:US
Practice Address - Phone:561-357-5636
Practice Address - Fax:561-357-7452
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP85450Medicare UPIN
FLU3103YMedicare ID - Type Unspecified