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General NPI Number Information
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NPI Number | 1679109540
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Entity Type | Individual
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Provider Name | MARA ANNE KRYVICKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 907 N FEDERAL HWY
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-3224
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Country | US
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Telephone | 248-762-8467
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 CLUBHOUSE ESTATES CT
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-1898
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Country | US
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Telephone | 561-798-4984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9111263
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License Number State | FL
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