Provider Demographics
NPI:1386255446
Name:CROYLE, MICHELLE R (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:CROYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 UINTA WAY UNIT E2
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7685
Mailing Address - Country:US
Mailing Address - Phone:435-604-0160
Mailing Address - Fax:435-731-8328
Practice Address - Street 1:1784 UINTA WAY UNIT E2
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7685
Practice Address - Country:US
Practice Address - Phone:435-604-0160
Practice Address - Fax:435-731-8328
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95160449163W00000X
363A00000X
UT13007674-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No163W00000XNursing Service ProvidersRegistered Nurse
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant