Provider Demographics
NPI:1659439339
Name:CROSS ROADS MEDICAL CLINIC
Entity Type:Organization
Organization Name:CROSS ROADS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-325-6334
Mailing Address - Street 1:9013 MAHAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-1474
Mailing Address - Country:US
Mailing Address - Phone:850-325-6334
Mailing Address - Fax:850-942-6322
Practice Address - Street 1:9013 MAHAN DR STE 201
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-1474
Practice Address - Country:US
Practice Address - Phone:850-325-6334
Practice Address - Fax:850-942-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3260402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty