MEDICARE: LURAJEAN AMAM CRAVENS CNP

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	363LF0000X	Family Nurse Practitioner	APRN11018504	FL
2	363LF0000X	Family Nurse Practitioner	CNP019321	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730632100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LURAJEAN AMAM CRAVENS CNP

Provider Business Mailing Address
First Line	:	76 OAKMOSS DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-5308
Country	:	US
Telephone Number	:	937-725-6753
Fax Number	:

Provider Business Practice Location Address
First Line	:	12303 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2830
Country	:	US
Telephone Number	:	904-288-0717
Fax Number	:

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

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	06/01/2026

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