Basic Information
| Provider Information | |||||||||
| NPI: | 1033634407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAKOVEC | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 COUNCIL MOORE RD | ||||||||
| Address2: | |||||||||
| City: | CRAWFORDVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323273117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509267105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 COUNCIL MOORE RD | ||||||||
| Address2: | |||||||||
| City: | CRAWFORDVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323273117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509267105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2017 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7501 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME134954 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.