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General NPI Number Information
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NPI Number | 1003099052
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Entity Type | Individual
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Provider Name | FALLON CREWS APRN
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Gender | Female
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 400 GULF BREEZE PKWY STE 300
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City | GULF BREEZE
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State | FL
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Zip | 32561-4458
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Country | US
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Telephone | 850-932-5055
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Fax | 850-932-1404
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | GULF BREEZE
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State | FL
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Zip | 32562-0280
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Country | US
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Telephone | 850-932-5055
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Fax | 850-934-1404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN226921
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN9267229
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License Number State | FL
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