Provider Demographics
NPI:1174720700
Name:KRUL, ANN MARIE (PA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:KRUL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6282 LINTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6416
Mailing Address - Country:US
Mailing Address - Phone:561-955-6400
Mailing Address - Fax:561-955-6618
Practice Address - Street 1:701 NW 13TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2305
Practice Address - Country:US
Practice Address - Phone:561-955-6400
Practice Address - Fax:561-955-6618
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003582363A00000X
FLPA9113717363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32070015Medicare PIN