Provider Demographics
NPI:1063819829
Name:CROWE, CARIANNE NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CARIANNE
Middle Name:NICOLE
Last Name:CROWE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARIANNE
Other - Middle Name:NICOLE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1320 LAS TABLAS ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465
Mailing Address - Country:US
Mailing Address - Phone:805-434-5563
Mailing Address - Fax:805-434-5916
Practice Address - Street 1:1320 LAS TABLAS ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465
Practice Address - Country:US
Practice Address - Phone:805-434-5563
Practice Address - Fax:805-434-5916
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51900OtherPHYSICIAN ASSISTANT LICENSE