Provider Demographics
NPI:1740725951
Name:KRAKOVA, SVETLANA
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:KRAKOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SVETLANA
Other - Middle Name:
Other - Last Name:KRAKOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4004 FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4524
Mailing Address - Country:US
Mailing Address - Phone:917-583-8972
Mailing Address - Fax:
Practice Address - Street 1:4004 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4524
Practice Address - Country:US
Practice Address - Phone:917-583-8972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382180-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner