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General NPI Number Information
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NPI Number | 1730707589
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Entity Type | Individual
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Provider Name | DUSTIN MICHAEL CROVO FNP, AG-ACNP, ENP
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Gender | Male
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 1201 S HAYES ST
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City | ARLINGTON
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State | VA
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Zip | 22202-2700
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Country | US
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Telephone | 703-418-3790
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Fax |
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Provider Business Mailing Address
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Address Line | 178 ZEUS MILL LN
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City | MADISON
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State | VA
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Zip | 22727-3110
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Country | US
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Telephone | 321-223-1723
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 11007688
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0024180482
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024180482
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License Number State | VA
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