Individual provider Active NPI

Kristin Vasser Blanco, APRN

  • Nurse Practitioner
  • Lake Mary, FL
National Provider Identifier
1255941605
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN11003769 Issued in FL
Practice address
805 Currency Cir
Lake Mary, FL 32746-2115
Phone
(407) 804-6133
Fax
(866) 447-9143
NPI assigned
Jul 31, 2020
Last updated
Apr 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN11003769 FL Primary
Family Nurse Practitioner 363LF0000X APRN11003769 FL

Addresses

Primary practice location

805 Currency Cir
Lake Mary, FL 32746-2115

Mailing address

PO Box 102222
Atlanta, GA 30368-2222
Phone (239) 432-8200

Other practice location 1

2415 N Orange Ave Ste 601
Orlando, FL 32804-5558
Phone (407) 303-2070

Other practice location 2

2572 W State Road 426 Ste 3080
Oviedo, FL 32765-8312
Phone (407) 565-2192

Other practice location 3

810 N Spring Garden Ave Ste 100
Deland, FL 32720-3106
Phone (386) 943-9446

Other practice location 4

765 Image Way
Orange City, FL 32763-8399
Phone (386) 774-7411

Other identifiers 1

IdentifierTypeStateIssuer
108070100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201013000563 FL Practitioner - Nurse Practitioner 2668892639 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2415 N Orange Ave
Suite 601
Orlando, FL 32804-5558
Phone (407) 303-2070

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11003769FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Nurse Practitioner CurrentSince Nov 30, 2020 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Nov 30, 2020 Accepting new patients
Florida Cancer Specialists & Research Institute, LLC CurrentSince Nov 2, 2022 Accepting new patients
Florida Cancer Specialists & Research Institute, LLC CurrentSince Nov 2, 2022 Accepting new patients

Locations

810 N Spring Garden Ave
Ste 100
Deland, FL 32720
Phone (386) 279-0060

805 Currency Cir
Lake Mary, FL 32746
Phone (407) 804-6133

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

765 Image Way
Orange City, FL 32763
Phone (386) 774-7411

2415 N Orange Ave
Ste 601
Orlando, FL 32804
Phone (407) 303-2070

2572 W State Road 426
Ste 3080
Oviedo, FL 32765
Phone (407) 565-2192

1970 Golf St
Fl Cancer
Sarasota, FL 34236
Phone (941) 795-3780

4420 Sun N Lake Blvd
Fl Cancer
Sebring, FL 33872
Phone (863) 385-1244

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: kblanco73869@adventhealth.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1596153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1255941605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102222",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682222",
            "telephone_number": "239-432-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 CURRENCY CIR",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462115",
            "telephone_number": "407-804-6133",
            "fax_number": "866-447-9143"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2415 N Orange Ave Ste 601",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328045558",
            "country_code": "US",
            "telephone_number": "407-303-2070",
            "fax_number": "407-303-2071",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2572 W State Road 426 Ste 3080",
            "address_purpose": "LOCATION",
            "city": "Oviedo",
            "state": "FL",
            "postal_code": "327658312",
            "country_code": "US",
            "telephone_number": "407-565-2192",
            "fax_number": "407-565-2285",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "810 N Spring Garden Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Deland",
            "state": "FL",
            "postal_code": "327203106",
            "country_code": "US",
            "telephone_number": "386-943-9446",
            "fax_number": "386-943-9385",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "765 Image Way",
            "address_purpose": "LOCATION",
            "city": "Orange City",
            "state": "FL",
            "postal_code": "327638399",
            "country_code": "US",
            "telephone_number": "386-774-7411",
            "fax_number": "386-774-7412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLANCO",
        "first_name": "KRISTIN",
        "middle_name": "VASSER",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-31",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11003769",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11003769",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108070100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.