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General NPI Number Information
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NPI Number | 1457414484
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Entity Type | Individual
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Provider Name | JACQUELINE ANN CROCETTI C.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 721 NEW RODGERS ROAD
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City | BRISTOL
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State | PA
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Zip | 19007
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Country | US
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Telephone | 215-785-4594
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Fax |
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Provider Business Mailing Address
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Address Line | 569 COON HOLLOW RD
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City | RIEGELSVILLE
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State | PA
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Zip | 18077-9773
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Country | US
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Telephone |
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Fax |
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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 | VP003876B
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License Number State | PA
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