Provider Demographics
NPI:1144539909
Name:KROGEN, TONI M (AA-C)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:KROGEN
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:M
Other - Last Name:WILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA-C
Mailing Address - Street 1:1613 N. HARRISON PARKWAY #200
Mailing Address - Street 2:MAIL STOP SH-9A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2853
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:800 MEADOWS ROAD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-395-7100
Practice Address - Fax:561-955-5162
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA73367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002744700Medicaid
FLDS574ZMedicare PIN