Provider Demographics
NPI:1114755170
Name:MCCRACKEN, EMILY ROSE (CAA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:CAA
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Other - Credentials:
Mailing Address - Street 1:98 WHEELWRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8329
Mailing Address - Country:US
Mailing Address - Phone:904-635-3868
Mailing Address - Fax:
Practice Address - Street 1:919 E 32ND ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2703
Practice Address - Country:US
Practice Address - Phone:512-544-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant