Healthcare Provider Details

I. General information

NPI: 1649467366
Provider Name (Legal Business Name): KATRINIA L KRAEMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/29/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 US HWY 1 SOUTH
ST AUGUSTINE FL
32086
US

IV. Provider business mailing address

4255 US HIGHWAY 1 S STE 18
ST AUGUSTINE FL
32086-7002
US

V. Phone/Fax

Practice location:
  • Phone: 904-495-1610
  • Fax:
Mailing address:
  • Phone: 904-495-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11022520
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number667137
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: