Healthcare Provider Details

I. General information

NPI: 1518927763
Provider Name (Legal Business Name): JOHN CROKER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E MINNESOTA AVE
ORANGE CITY FL
32763-2312
US

IV. Provider business mailing address

341 W MINNESOTA AVE
ORANGE CITY FL
32763-2205
US

V. Phone/Fax

Practice location:
  • Phone: 386-241-0274
  • Fax: 386-241-0275
Mailing address:
  • Phone: 386-241-0274
  • Fax: 386-241-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 3333802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: