Provider Demographics
NPI:1083245989
Name:CRENSHAW, EMILY E
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PARKBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3381
Mailing Address - Country:US
Mailing Address - Phone:229-938-5425
Mailing Address - Fax:
Practice Address - Street 1:3269 S US HIGHWAY 231 STE 123
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-0856
Practice Address - Country:US
Practice Address - Phone:850-896-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program