Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN 2165662 | FL |
NPI | 1003275157 |
---|---|
Provider Name | Ms. Kelli Kraaz |
First Address | Fort Pierce, FL 34946-8418 |
Second Address | Fort Pierce, FL 34946-8418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2016 |
Last Update Date | 17/02/2016 |