Healthcare Provider Details

I. General information

NPI: 1760357719
Provider Name (Legal Business Name): SHORES HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GRACIELA CIR
ST AUGUSTINE FL
32086-7837
US

IV. Provider business mailing address

308 GRACIELA CIR
ST AUGUSTINE FL
32086-7837
US

V. Phone/Fax

Practice location:
  • Phone: 210-508-5621
  • Fax:
Mailing address:
  • Phone: 210-508-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATRINIA KRAEMER
Title or Position: FAMILY NURSE PRACTITIONER
Credential: APRN
Phone: 904-495-1610