Provider Demographics
NPI:1285045427
Name:CROFT, TERESA BARAJAS (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:BARAJAS
Last Name:CROFT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:BARAJAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 6020
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-6020
Mailing Address - Country:US
Mailing Address - Phone:605-217-5610
Mailing Address - Fax:
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2010
Practice Address - Fax:712-279-2034
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant