Provider Demographics
NPI:1730707589
Name:CROVO, DUSTIN MICHAEL (FNP, AG-ACNP, ENP)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:MICHAEL
Last Name:CROVO
Suffix:
Gender:M
Credentials:FNP, AG-ACNP, ENP
Other - Prefix:
Other - First Name:DUSTIN
Other - Middle Name:MICHAEL
Other - Last Name:CROVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP, AG-ACNP, ENP
Mailing Address - Street 1:178 ZEUS MILL LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:VA
Mailing Address - Zip Code:22727-3110
Mailing Address - Country:US
Mailing Address - Phone:321-223-1723
Mailing Address - Fax:
Practice Address - Street 1:1201 S HAYES ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2700
Practice Address - Country:US
Practice Address - Phone:703-418-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007688207P00000X
VA0024180482363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology