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NPI Code Detail

MEDICARE: MRS. TIA TONETTE HALEY-CRAWFORD FNP-C

MEDICARE: MRS. TIA TONETTE HALEY-CRAWFORD FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAPRN-NP212350GA

General Provider Information

NPI Number : 1558210419
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TIA TONETTE HALEY-CRAWFORD FNP-C
Provider Business Mailing Address
First Line : 7 GOOSE NECK RD
Second Line :
City : PORT WENTWORTH
State : GA
Zip : 31407-6001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7 GOOSE NECK RD
Second Line :
City : PORT WENTWORTH
State : GA
Zip : 31407-6001
Country : US
Telephone Number : 191-227-2989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2026
Last Update Date : 01/24/2026

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