Healthcare Provider Details

I. General information

NPI: 1295388379
Provider Name (Legal Business Name): ERIKA CROCKETT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA BENNETT NP

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 TECHNOLOGY LN # LE
JOHNSON CITY TN
37604-2004
US

IV. Provider business mailing address

1643 NW 136TH AVE BLDG H
SUNRISE FL
33323-3091
US

V. Phone/Fax

Practice location:
  • Phone: 423-434-2016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26403
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: