Provider Demographics
NPI:1417420498
Name:CROOK, JARED ANTHONY (FNP)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:ANTHONY
Last Name:CROOK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130940
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0940
Mailing Address - Country:US
Mailing Address - Phone:903-593-9999
Mailing Address - Fax:
Practice Address - Street 1:3110 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9215
Practice Address - Country:US
Practice Address - Phone:903-593-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP140069OtherTEXAS BOARD OF NURSING