MEDICARE: INDIA CROSSKE

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	163W00000X	Registered Nurse	9599885	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1790578334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDIA CROSSKE

Provider Business Mailing Address
First Line	:	11090 FGCU BLVD N
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33965-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11090 FGCU BLVD N
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33965-0001
Country	:	US
Telephone Number	:	239-590-1150
Fax Number	:

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

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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Directions to “ INDIA CROSSKE ” Practice Location

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