Provider Demographics
NPI:1376745596
Name:CROWNINGSHIELD, DEANNA GRAHAM (ARNP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:GRAHAM
Last Name:CROWNINGSHIELD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9473 SOUTHERN GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1273
Mailing Address - Country:US
Mailing Address - Phone:407-383-9588
Mailing Address - Fax:
Practice Address - Street 1:120 BENMORE DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4101
Practice Address - Country:US
Practice Address - Phone:407-645-5998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3416852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily