Provider Demographics
NPI:1659509586
Name:CRAWFORD, TORI D (NP)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:D
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:A
Other - Last Name:DOOLITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:121 SOTOYOME ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4834
Mailing Address - Country:US
Mailing Address - Phone:707-526-4078
Mailing Address - Fax:707-545-1145
Practice Address - Street 1:121 SOTOYOME ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4834
Practice Address - Country:US
Practice Address - Phone:707-526-4078
Practice Address - Fax:707-545-1145
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 18972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659509586Medicaid
CANP0189720OtherBLUE SHIELD
CAP00759212OtherRAILROAD MEDICARE
CACD800ZMedicare PIN
CAP00759212OtherRAILROAD MEDICARE