=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093342420
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANISHA CROCKETT FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2020
-----------------------------------------------------
Last Update Date | 11/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29787 JOHN J WILLIAMS HWY UNIT 8
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-4097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-818-8680
-----------------------------------------------------
Fax | 866-229-0237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29787 JOHN J WILLIAMS HWY UNIT 8
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-4097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-818-8680
-----------------------------------------------------
Fax | 866-229-0237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | LG-0001373
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------