Healthcare Provider Details

I. General information

NPI: 1164458691
Provider Name (Legal Business Name): LORRAINE KRYVICKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 N FEDERAL HWY FL 2
BOYNTON BEACH FL
33435-3224
US

IV. Provider business mailing address

907 N FEDERAL HWY FL 2
BOYNTON BEACH FL
33435-3224
US

V. Phone/Fax

Practice location:
  • Phone: 561-708-5551
  • Fax: 561-708-5655
Mailing address:
  • Phone: 561-708-5551
  • Fax: 561-708-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101864
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: