MEDICARE: TINA RENEE KRUG CNA

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	374U00000X	Home Health Aide		AZ

General Provider Information

NPI Number	:	1255106803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA RENEE KRUG CNA

Provider Business Mailing Address
First Line	:	2666 N ALVERNON WAY APT B231
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1729
Country	:	US
Telephone Number	:	520-302-9239
Fax Number	:

Provider Business Practice Location Address
First Line	:	2666 N ALVERNON WAY APT B231
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1729
Country	:	US
Telephone Number	:	520-302-9239
Fax Number	:

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

Provider Enumeration Date	:	11/22/2023
Last Update Date	:	11/22/2023

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