Healthcare Provider Details

I. General information

NPI: 1992032254
Provider Name (Legal Business Name): ANDREA S. KRADMAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 08/18/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLEVELAND CLINIC MARTIN SOUTH HOSPITAL 2100 SE SALERNO ROAD
STUART FL
34997
US

IV. Provider business mailing address

ONE CVS DRIVE CVS/CAREMARK/MINUTECLINIC
WOONSOCKET RI
02895
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-2300
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007855
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9270643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: