MEDICARE: CHRISTINE KRIKLAVA AGNP-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	363LA2200X	Adult Health Nurse Practitioner	311756	NY

General Provider Information

NPI Number	:	1871320887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE KRIKLAVA AGNP-C

Provider Business Mailing Address
First Line	:	101 NICOLLS RD
Second Line	:	HSC T19-068
City	:	STONY BROOK
State	:	NY
Zip	:	11794
Country	:	US
Telephone Number	:	631-444-9044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 LAUTERBUR DR
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-0001
Country	:	US
Telephone Number	:	631-444-9044
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	02/20/2026

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