Provider Demographics
NPI:1326587106
Name:CREWS, RONDA (ARNP)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:CREWS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:RONDA
Other - Middle Name:
Other - Last Name:CREWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1370 13TH AVE S STE 218
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3206
Mailing Address - Country:US
Mailing Address - Phone:904-853-6154
Mailing Address - Fax:904-853-6412
Practice Address - Street 1:1370 13TH AVE S STE 218
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3206
Practice Address - Country:US
Practice Address - Phone:904-853-6154
Practice Address - Fax:904-853-6412
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9227420363LF0000X
FLRP9227420363LF0000X
FLARNP9227420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020029400Medicaid