Provider Demographics
NPI:1154668192
Name:KRUKOWSKI, HOLLY ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:KRUKOWSKI
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 1:15909 SAN FELIPE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6505
Mailing Address - Country:US
Mailing Address - Phone:361-949-3274
Mailing Address - Fax:
Practice Address - Street 1:15909 SAN FELIPE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6505
Practice Address - Country:US
Practice Address - Phone:361-949-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX795231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily