Provider Demographics
NPI:1578227831
Name:CROOKS, DENETRA NEKIA
Entity Type:Individual
Prefix:
First Name:DENETRA
Middle Name:NEKIA
Last Name:CROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENETRA
Other - Middle Name:NEKIA
Other - Last Name:AARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3702 TAM DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3643
Mailing Address - Country:US
Mailing Address - Phone:321-888-5353
Mailing Address - Fax:
Practice Address - Street 1:260 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5510
Practice Address - Country:US
Practice Address - Phone:321-888-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113940400Medicaid