Healthcare Provider Details

I. General information

NPI: 1518876325
Provider Name (Legal Business Name): CARRIE CROCHETIERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 N CONANT AVE
CRYSTAL RIVER FL
34429-7512
US

IV. Provider business mailing address

1009 N CONANT AVE
CRYSTAL RIVER FL
34429-7512
US

V. Phone/Fax

Practice location:
  • Phone: 352-345-9818
  • Fax:
Mailing address:
  • Phone: 352-345-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9702420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: