Provider Demographics
NPI:1174917819
Name:CROOM, ANDREA LYNELL (AGNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNELL
Last Name:CROOM
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CROOM
Other - Last Name:BARTOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:911 S HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-7731
Mailing Address - Country:US
Mailing Address - Phone:919-363-6011
Mailing Address - Fax:919-363-6013
Practice Address - Street 1:911 S HUGHES ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-7731
Practice Address - Country:US
Practice Address - Phone:919-363-6001
Practice Address - Fax:919-363-6013
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007537363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology