Basic Information
| Provider Information | |||||||||
| NPI: | 1467629980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACARAEG | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | IDHS, NREMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 EAGLE RD BLDG 42 | ||||||||
| Address2: | |||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945015101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274036599 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15100 RESCUE WAY | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337623502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275351437 | ||||||||
| FaxNumber: | 7275354190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2008 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146N00000X | N | Emergency Medical Service Providers | Emergency Medical Technician, Basic | 171000000X | N | Other Service Providers | Military Health Care Provider | 1710I1002X | N | Other Service Providers | Military Health Care Provider | Independent Duty Corpsman | 1710I1003X | Y | Other Service Providers | Military Health Care Provider | Independent Duty Medical Technicians |
No ID Information.