Provider Demographics
NPI:1508974411
Name:CROXTON, DIANA M (RD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:CROXTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 SW WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4333
Mailing Address - Country:US
Mailing Address - Phone:772-283-4954
Mailing Address - Fax:
Practice Address - Street 1:2348 SE OCEAN BLVD
Practice Address - Street 2:TREASURE COAST KIDNEY CTR - NORTH - CKD SERVICES
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3310
Practice Address - Country:US
Practice Address - Phone:772-286-2470
Practice Address - Fax:772-223-5829
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND208133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal