Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2211352 | FL |
NPI | 1023090446 |
---|---|
Provider Name | Mrs. Diana Van Precht Crowe |
First Address | Fleming Island, FL 32003-4529 |
Second Address | Jacksonville, FL 32210-8046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2005 |
Last Update Date | 01/09/2010 |