Provider Demographics
NPI:1386483576
Name:CROUCH, EMILY JANE (DOM)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:CROUCH
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 SEMINOLE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3240
Mailing Address - Country:US
Mailing Address - Phone:727-515-0606
Mailing Address - Fax:
Practice Address - Street 1:11200 SEMINOLE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3240
Practice Address - Country:US
Practice Address - Phone:727-515-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4571171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist