Healthcare Provider Details

I. General information

NPI: 1932343506
Provider Name (Legal Business Name): SHANNON RENEE KRATZBERG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 SW 20TH AVE
OCALA FL
34471-0163
US

IV. Provider business mailing address

7360 SW 199TH TER
DUNNELLON FL
34431-5138
US

V. Phone/Fax

Practice location:
  • Phone: 352-873-3800
  • Fax: 352-873-4800
Mailing address:
  • Phone: 352-873-3800
  • Fax: 352-873-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9175753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: