Provider Demographics
NPI:1427022763
Name:KRATKY, SUSAN R (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:KRATKY
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:PO BOX 409471
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9471
Mailing Address - Country:US
Mailing Address - Phone:888-336-9121
Mailing Address - Fax:561-955-1761
Practice Address - Street 1:21020 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1320
Practice Address - Country:US
Practice Address - Phone:561-883-7502
Practice Address - Fax:561-218-6262
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9232726164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6474ZMedicare ID - Type Unspecified
FLQ57406Medicare UPIN