Basic Information
| Provider Information | |||||||||
| NPI: | 1194839332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KREUL | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2727 W DR MARTIN LUTHER KING JR BLVD STE 800 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138730000 | ||||||||
| FaxNumber: | 8138733659 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 W DR MLK BLVD STE 800 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138730000 | ||||||||
| FaxNumber: | 8138733659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC3500X | ARNP1795932 | FL | N | Nursing Service Providers | Registered Nurse | Cardiac Rehabilitation | 363L00000X | APRN1795932 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 305155200 | 05 | FL | MEDICAID | P00094026 | 01 | FL | RR MEDICARE | OTHER |