Provider Demographics
NPI:1487949822
Name:GLOR CROCKER, ASHLEY L (CRNA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:GLOR CROCKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:L
Other - Last Name:GLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3100 SPRING FOREST ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:919-882-0705
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:5801 BREMO ROAD
Practice Address - Street 2:AMERICAN ANESTHESIOLOGY OF VIRGINIA, PC
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:973-660-9334
Practice Address - Fax:732-235-6131
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00340600367500000X
VA0024171756367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ229529A01Medicare PIN