Provider Demographics
NPI:1932679420
Name:KRUG, KRISTINA BREITLING (NCPS, CRPS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:BREITLING
Last Name:KRUG
Suffix:
Gender:F
Credentials:NCPS, CRPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 MOSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8348
Mailing Address - Country:US
Mailing Address - Phone:904-646-6392
Mailing Address - Fax:
Practice Address - Street 1:1735 MOSS CREEK DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8348
Practice Address - Country:US
Practice Address - Phone:904-646-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0000X, 3747P1801X
FL549175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No175T00000XOther Service ProvidersPeer Specialist