Provider Demographics
NPI:1104852250
Name:KRANCE, ROBERTA L (ARNP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:L
Last Name:KRANCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3466 N HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5713
Mailing Address - Country:US
Mailing Address - Phone:321-434-1982
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:3661 S BABCOCK ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8205
Practice Address - Country:US
Practice Address - Phone:321-434-7606
Practice Address - Fax:321-434-7610
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP997992363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0000000000OtherUPIN PENDING
FL0000000000OtherUPIN PENDING