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General NPI Number Information
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NPI Number | 1558210419
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Entity Type | Individual
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Provider Name | TIA TONETTE HALEY-CRAWFORD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2026
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Last Update Date | 01/24/2026
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Provider Practice Location Address
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Address Line | 7 GOOSE NECK RD
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-6001
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Country | US
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Telephone | 191-227-2989
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GOOSE NECK RD
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-6001
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN-NP212350
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License Number State | GA
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