Provider Demographics
NPI:1578989208
Name:CROCE, DEBRA A I
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:CROCE
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:476 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1533
Mailing Address - Country:US
Mailing Address - Phone:631-244-8602
Mailing Address - Fax:
Practice Address - Street 1:476 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1533
Practice Address - Country:US
Practice Address - Phone:631-244-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315367164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse