Provider Demographics
NPI:1073501805
Name:KRAWCZYK, MICHELLE M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:KRAWCZYK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9143 PHILIPS HWY
Mailing Address - Street 2:STE 560
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1348
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:1375 ROBERTS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3210
Practice Address - Country:US
Practice Address - Phone:904-997-3800
Practice Address - Fax:904-997-9899
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3053152363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306356900Medicaid
FL306356900Medicaid
FLP00273352Medicare PIN
FLE8843TMedicare PIN
FLE8843VMedicare PIN
FLE8843SMedicare PIN