Provider Demographics
NPI:1700418886
Name:WASHINGTON, CRECIE MAE (CNA)
Entity Type:Individual
Prefix:MS
First Name:CRECIE
Middle Name:MAE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 DEER RUN TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1066
Mailing Address - Country:US
Mailing Address - Phone:904-486-6883
Mailing Address - Fax:904-738-8042
Practice Address - Street 1:2172 DEER RUN TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-1066
Practice Address - Country:US
Practice Address - Phone:904-486-6883
Practice Address - Fax:904-738-8042
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA201408376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide