Provider Demographics
NPI:1477201788
Name:DRAGOO-KRASKOVIC, HALEY N (FNP-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:N
Last Name:DRAGOO-KRASKOVIC
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:NICOL
Other - Last Name:KRASKOVIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:19026 RIDGEWOOD PKWY STE 119
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-5500
Mailing Address - Country:US
Mailing Address - Phone:720-862-8883
Mailing Address - Fax:
Practice Address - Street 1:19026 RIDGEWOOD PKWY STE 119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-5500
Practice Address - Country:US
Practice Address - Phone:720-862-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073048363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care