Provider Demographics
NPI:1508831025
Name:CRINKLAW, PAULA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ANN
Last Name:CRINKLAW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 W FRONTIER ST
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-9134
Mailing Address - Country:US
Mailing Address - Phone:602-228-2254
Mailing Address - Fax:
Practice Address - Street 1:1485 W FRONTIER ST
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220
Practice Address - Country:US
Practice Address - Phone:602-228-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS37039Medicare UPIN