MEDICARE: DENETRA NEKIA CROOKS

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	253Z00000X	In Home Supportive Care Agency
2	376J00000X	Homemaker
3	376K00000X	Nurse's Aide	185571	FL
4	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1578227831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENETRA NEKIA CROOKS

Provider Business Mailing Address
First Line	:	801 W STATE ROAD 436 STE 2039
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3053
Country	:	US
Telephone Number	:	321-304-7170
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 W STATE ROAD 436 STE 2039
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3053
Country	:	US
Telephone Number	:	321-304-7170
Fax Number	:

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

Provider Enumeration Date	:	10/23/2021
Last Update Date	:	09/07/2024

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