Kristin Lea Hood Provencher, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

ARNP 9265639 Issued in FL

Practice address

615 E Princeton St
Suite 510
Orlando, FL 32803-1456

Phone

(407) 898-1210

Fax

(407) 898-2909

NPI assigned

Oct 17, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399248000000",
    "number": "1215280037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 691597",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328691597",
            "telephone_number": "407-898-1210",
            "fax_number": "407-898-2909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 E PRINCETON ST",
            "address_2": "SUITE 510",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031456",
            "telephone_number": "407-898-1210",
            "fax_number": "407-898-2909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "KRISTIN",
        "middle_name": "LEA HOOD",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-17",
        "last_updated": "2014-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP 9265639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007190500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "Y0E9G",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prosthesis Solutions & Supply, LLC
• Michael Jan Protasewicz Jr., APRN
• Protean Biodiagnostics Inc
• Protean Pathology Services LLC
• Rachel Andie Simon Proulx, MPT
• Providence Academy, Inc
• Providence Dental LLC
• Providence Home
• Providence Personal Care PPC
• Juliet D Providence

• Pediatric Nurse Practitioner in Orlando, FL
• Providers in Orlando, FL by specialty
• Pediatric Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.