Healthcare Provider Details

I. General information

NPI: 1952886830
Provider Name (Legal Business Name): JENNIFER HOGAN CROTEAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE
PORTLAND ME
04102-2363
US

IV. Provider business mailing address

324 GANNETT DR
SOUTH PORTLAND ME
04106-3270
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-8217
  • Fax:
Mailing address:
  • Phone: 603-321-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1866
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: