Healthcare Provider Details

I. General information

NPI: 1174720700
Provider Name (Legal Business Name): ANN MARIE KRUL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW 13TH ST FL 2
BOCA RATON FL
33486-2305
US

IV. Provider business mailing address

6282 LINTON BLVD
DELRAY BEACH FL
33484-6416
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-6400
  • Fax: 561-955-6618
Mailing address:
  • Phone: 561-955-6400
  • Fax: 561-955-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003582
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: