Provider Demographics
NPI:1598221384
Name:CRUM, ANNA (RD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CRUM
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 1:5212 WOOD CIR E
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-9537
Mailing Address - Country:US
Mailing Address - Phone:850-339-4279
Mailing Address - Fax:
Practice Address - Street 1:5212 WOOD CIR E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-9537
Practice Address - Country:US
Practice Address - Phone:850-339-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8797133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered