Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | APRN9243503 | FL |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN9243503 | FL |
NPI | 1033771167 |
---|---|
Provider Name | Mrs. Anne Elizabeth Crockett |
First Address | Boca Raton, FL 33496-2473 |
Second Address | Boca Raton, FL 33487-2861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2019 |
Last Update Date | 19/08/2021 |