Provider Demographics
NPI:1962716803
Name:PRENDERGAST, KRISTI A (APRN)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:A
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:61 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-0279
Mailing Address - Country:US
Mailing Address - Phone:419-304-4555
Mailing Address - Fax:904-656-7477
Practice Address - Street 1:7901 4TH ST N # 29055
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:904-257-3160
Practice Address - Fax:904-656-7477
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9259886363LF0000X
TX1064417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily