MEDICARE: MS. MARA ANNE KRYVICKY 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	363A00000X	Physician Assistant	PA9111263	FL

General Provider Information

NPI Number	:	1679109540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARA ANNE KRYVICKY PA-C

Provider Business Mailing Address
First Line	:	1703 CLUBHOUSE ESTATES CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-1898
Country	:	US
Telephone Number	:	561-798-4984
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 N FEDERAL HWY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-3224
Country	:	US
Telephone Number	:	248-762-8467
Fax Number	:

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

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	03/23/2020

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