Basic Information
| Provider Information | |||||||||
| NPI: | 1194108928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAVES | ||||||||
| FirstName: | KRISANN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 92 W MILLER ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218433220 | ||||||||
| FaxNumber: | 3218433210 | ||||||||
| Practice Location | |||||||||
| Address1: | 92 W MILLER ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218433220 | ||||||||
| FaxNumber: | 3218433210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2015 | ||||||||
| LastUpdateDate: | 05/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | APRN9164921 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 015655100 | 05 | FL | MEDICAID |