MEDICARE: GRETCHEN L KRONENTHAL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	055-0030753	VT
2	363A00000X	Physician Assistant	PA 9104147	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144299579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN L KRONENTHAL PA-C

Provider Business Mailing Address
First Line	:	14690 SPRING HILL DR STE 305
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-8102
Country	:	US
Telephone Number	:	352-277-5348
Fax Number	:	352-606-2857

Provider Business Practice Location Address
First Line	:	9030 W FORT ISLAND TRL STE 1
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-8011
Country	:	US
Telephone Number	:	352-228-8906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/15/2019

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Directions to “ GRETCHEN L KRONENTHAL PA-C” Practice Location

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