Provider Demographics
NPI:1275944597
Name:BARICEVAC, KRISTIN (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BARICEVAC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:BOLOGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:781 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2438
Mailing Address - Country:US
Mailing Address - Phone:267-978-8734
Mailing Address - Fax:
Practice Address - Street 1:2 READS WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1607
Practice Address - Country:US
Practice Address - Phone:302-709-4709
Practice Address - Fax:302-709-4704
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10041157163W00000X
DEL6-0A00703367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse