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General NPI Number Information
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NPI Number | 1144699943
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Entity Type | Individual
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Provider Name | MS. SALAETHIA MARTRIA CRAWFORD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 200 BLUE MOON XING STE 203
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City | POOLER
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State | GA
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Zip | 31322-9698
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Country | US
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Telephone | 912-590-0973
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Fax | 912-590-0180
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Provider Business Mailing Address
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Address Line | 5191 FIRST COAST TECH PKWY FL 3
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City | JACKSONVILLE
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State | FL
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Zip | 32224-0609
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Country | US
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Telephone | 904-223-3321
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Fax | 904-223-2169
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN154895
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License Number State | GA
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