Provider Demographics
NPI:1023090446
Name:CROWE, DIANA VAN PRECHT (ARNP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:VAN PRECHT
Last Name:CROWE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 WATER OAK LN
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4529
Mailing Address - Country:US
Mailing Address - Phone:904-284-7897
Mailing Address - Fax:
Practice Address - Street 1:5126 TIMUQUANA RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8046
Practice Address - Country:US
Practice Address - Phone:904-777-4228
Practice Address - Fax:904-777-0012
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2211352363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301676500Medicare ID - Type Unspecified