Provider Demographics
NPI:1558830158
Name:CROASDAILE, KARINA VANNESSA (APRN)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:VANNESSA
Last Name:CROASDAILE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 SW 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3762
Mailing Address - Country:US
Mailing Address - Phone:305-788-8084
Mailing Address - Fax:
Practice Address - Street 1:3399 SW 142ND AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3762
Practice Address - Country:US
Practice Address - Phone:305-788-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine