Healthcare Provider Details

I. General information

NPI: 1982813903
Provider Name (Legal Business Name): LAURA LYNNE CROW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9504 E COLUMBUS DR
TAMPA FL
33619-7715
US

IV. Provider business mailing address

9918 BALAYE RUN DR APT 103
TAMPA FL
33619-7656
US

V. Phone/Fax

Practice location:
  • Phone: 813-664-4100
  • Fax: 813-664-4117
Mailing address:
  • Phone: 813-830-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN3095172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: