| NPI | 1760296362 |
|---|---|
| Other Name | KRYSTLE TALAG IVANOV |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11037342) |
| Enumeration Date | 2025-02-04 |
| Last Update Date | 2025-02-13 |