Provider Demographics
NPI:1447890991
Name:CABRERA, KRYSTINA ELISABETH (RN, BSN)
Entity type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:ELISABETH
Last Name:CABRERA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ROBIN HILL PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5710
Mailing Address - Country:US
Mailing Address - Phone:631-299-1799
Mailing Address - Fax:
Practice Address - Street 1:34 ROBIN HILL PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5710
Practice Address - Country:US
Practice Address - Phone:631-299-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY752370163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse