Provider Demographics
NPI:1477094753
Name:CROCETTI, EMILY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ELLEN
Last Name:CROCETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:ELLEN
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:FAMILY MEDICINE DEPARTMENT 6000 W US HWY 98
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FAMILY MEDICINE DEPARTMENT 6000 W US HWY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-1200
Practice Address - Country:US
Practice Address - Phone:850-505-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine