Basic Information
Provider Information
NPI: 1285241497
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CREWS
FirstName: JOSHUA
MiddleName: CALEB
NamePrefix:  
NameSuffix:  
Credential: APRN FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14690 SPRING HILL DR STE 305
Address2:  
City: SPRING HILL
State: FL
PostalCode: 346098102
CountryCode: US
TelephoneNumber: 3522775348
FaxNumber: 3526062857
Practice Location
Address1: 5350 SPRING HILL DR
Address2:  
City: SPRING HILL
State: FL
PostalCode: 346064562
CountryCode: US
TelephoneNumber: 3526888116
FaxNumber: 3526869477
Other Information
ProviderEnumerationDate: 09/30/2020
LastUpdateDate: 06/21/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X11009445FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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