Healthcare Provider Details

I. General information

NPI: 1699012179
Provider Name (Legal Business Name): LAURA K CROOK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 04/13/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 VONDERBURG DR
BRANDON FL
33511-5954
US

IV. Provider business mailing address

915 BRIGGETT LN
LUTZ FL
33548-7908
US

V. Phone/Fax

Practice location:
  • Phone: 918-289-6617
  • Fax:
Mailing address:
  • Phone: 918-289-6617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number94478
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: