Basic Information
| Provider Information | |||||||||
| NPI: | 1932343506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRATZBERG | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7360 SW 199TH TER | ||||||||
| Address2: | |||||||||
| City: | DUNNELLON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344315138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528733800 | ||||||||
| FaxNumber: | 3528734800 | ||||||||
| Practice Location | |||||||||
| Address1: | 4460 SW 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528733800 | ||||||||
| FaxNumber: | 3528734800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2009 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9175753 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.