MEDICARE: JACLYN KRAMER RN

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	163W00000X	Registered Nurse	RN9412159	FL
2	367500000X	Certified Registered Nurse Anesthetist	11010741	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

General Provider Information

NPI Number	:	1992314702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN KRAMER RN

Provider Business Mailing Address
First Line	:	19202 CINNAMON RIDGE WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3623
Country	:	US
Telephone Number	:	813-293-0319
Fax Number	:

Provider Business Practice Location Address
First Line	:	19202 CINNAMON RIDGE WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3623
Country	:	US
Telephone Number	:	813-293-0319
Fax Number	:

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

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	02/01/2021

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