MEDICARE: BREANNA CROWDER

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
1	363L00000X	Nurse Practitioner	APRN11025113	FL

General Provider Information

NPI Number	:	1770284465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA CROWDER

Provider Business Mailing Address
First Line	:	4953 WHITE SANDERLING CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-0823
Country	:	US
Telephone Number	:	863-701-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4953 WHITE SANDERLING CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-0823
Country	:	US
Telephone Number	:	863-701-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	03/10/2023

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Directions to “ BREANNA CROWDER ” Practice Location

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