Provider Demographics
NPI:1891542445
Name:SURACI, KRISTEN RENEE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:RENEE
Last Name:SURACI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11769 TREVALLY LOOP APT 109
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-0050
Mailing Address - Country:US
Mailing Address - Phone:727-515-0949
Mailing Address - Fax:
Practice Address - Street 1:11769 TREVALLY LOOP APT 109
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-0050
Practice Address - Country:US
Practice Address - Phone:727-515-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14040225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist