Provider Demographics
NPI:1386358182
Name:CRUTCHFIELD, NEKIA C (MASTER DERMATOLOGY)
Entity type:Individual
Prefix:MISS
First Name:NEKIA
Middle Name:C
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:MASTER DERMATOLOGY
Other - Prefix:
Other - First Name:NEKIA
Other - Middle Name:C
Other - Last Name:CRUTCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-3356
Mailing Address - Country:US
Mailing Address - Phone:772-360-2080
Mailing Address - Fax:
Practice Address - Street 1:212 N 28TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-3356
Practice Address - Country:US
Practice Address - Phone:772-360-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC623632865610207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology