Provider Demographics
NPI:1972582625
Name:CROWTHERS, WILL R (CRNA)
Entity type:Individual
Prefix:
First Name:WILL
Middle Name:R
Last Name:CROWTHERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:TOBY
Other - Middle Name:
Other - Last Name:CROWTHERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 840237
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33084-2237
Mailing Address - Country:US
Mailing Address - Phone:954-831-2371
Mailing Address - Fax:
Practice Address - Street 1:1613 N. HARRISON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:954-838-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1363932367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1407OtherBCBS
FLG1407OtherBCBS
FLG1407TMedicare ID - Type Unspecified