Provider Demographics
NPI:1114618923
Name:CROUCH, JAMIE L (AGACNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:CROUCH
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:HOPPING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4358 CHERRY LAKE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-3978
Mailing Address - Country:US
Mailing Address - Phone:904-487-6760
Mailing Address - Fax:
Practice Address - Street 1:4358 CHERRY LAKE LN
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-3978
Practice Address - Country:US
Practice Address - Phone:904-487-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026336363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care