Provider Demographics
NPI:1063696698
Name:CROW, ANNE MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:CROW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5731 BUCK WARD RD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:FL
Mailing Address - Zip Code:32531-8409
Mailing Address - Country:US
Mailing Address - Phone:850-420-4776
Mailing Address - Fax:850-689-7933
Practice Address - Street 1:1200 E JAMES LEE BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-3126
Practice Address - Country:US
Practice Address - Phone:850-420-4776
Practice Address - Fax:850-689-7933
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9182497363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL312296401Medicaid
FLY00Y9OtherBCBSFL
FL312296401Medicaid