Healthcare Provider Details

I. General information

NPI: 1548962137
Provider Name (Legal Business Name): TYLER DAVID CROFTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 MIDDLESEX CORPORATE PKWY
MIDDLESEX NC
27557-4201
US

IV. Provider business mailing address

7620 MIDDLESEX CORPORATE PKWY
MIDDLESEX NC
27557-4201
US

V. Phone/Fax

Practice location:
  • Phone: 252-235-2298
  • Fax: 252-235-3362
Mailing address:
  • Phone:
  • Fax: 252-235-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: