Provider Demographics
NPI:1215386578
Name:CROWDIS, MARISSA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:ANN
Last Name:CROWDIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 W HILLSBORO BLVD APT 307
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4311
Mailing Address - Country:US
Mailing Address - Phone:817-965-7112
Mailing Address - Fax:
Practice Address - Street 1:1225 S GEAR AVE STE 251
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1688
Practice Address - Country:US
Practice Address - Phone:319-768-3700
Practice Address - Fax:319-768-3712
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO5023390200000X
IADO-055712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program