MEDICARE: NIKOLAS CROCKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	11027933	FL

General Provider Information

NPI Number	:	1326720475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLAS CROCKER

Provider Business Mailing Address
First Line	:	11401 SW 49TH PL
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33330-2806
Country	:	US
Telephone Number	:	786-356-5035
Fax Number	:

Provider Business Practice Location Address
First Line	:	11401 SW 49TH PL
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33330-2806
Country	:	US
Telephone Number	:	786-356-5035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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Directions to “ NIKOLAS CROCKER ” Practice Location

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