Provider Demographics
NPI:1518927763
Name:CROKER, JOHN (ARNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CROKER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 W MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-2205
Mailing Address - Country:US
Mailing Address - Phone:386-241-0274
Mailing Address - Fax:386-241-0275
Practice Address - Street 1:135 E MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-2312
Practice Address - Country:US
Practice Address - Phone:386-241-0274
Practice Address - Fax:386-241-0275
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3333802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305918900Medicaid
FLU1748ZMedicare ID - Type Unspecified
FL305918900Medicaid
FLU1748XMedicare PIN
FLU1748TMedicare PIN