Provider Demographics
NPI:1801212113
Name:CRAWFORD, REBECCA G (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:G
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:GRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:394 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9150
Practice Address - Country:US
Practice Address - Phone:843-347-8765
Practice Address - Fax:843-347-3499
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1082304OtherWELLCARE
SC80023023OtherSELECT HEALTH
SCP01383226OtherRR MEDICARE
SC7151951OtherAETNA
SC30177579OtherSELECT HEALTH
SCNP2744Medicaid
SC1082304OtherWELLCARE