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General NPI Number Information
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NPI Number | 1932679420
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Entity Type | Individual
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Provider Name | KRISTINA BREITLING KRUG NCPS, CRPS
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Gender | Female
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 1735 MOSS CREEK DR
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-8348
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Country | US
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Telephone | 904-646-6392
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Fax |
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Provider Business Mailing Address
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Address Line | 1735 MOSS CREEK DR
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-8348
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Country | US
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Telephone | 904-646-6392
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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 | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 549
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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