Provider Demographics
NPI:1083426845
Name:CROCKER, SPASAH
Entity type:Individual
Prefix:
First Name:SPASAH
Middle Name:
Last Name:CROCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 GEORGE WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23702-2403
Mailing Address - Country:US
Mailing Address - Phone:757-447-2668
Mailing Address - Fax:757-401-4819
Practice Address - Street 1:4515 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23702-2403
Practice Address - Country:US
Practice Address - Phone:757-447-2668
Practice Address - Fax:757-401-4819
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care