Provider Demographics
NPI:1851052534
Name:CROCKETT, ABREASCIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ABREASCIA
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 MABEL DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-6900
Mailing Address - Country:US
Mailing Address - Phone:334-451-0724
Mailing Address - Fax:
Practice Address - Street 1:1820 MABEL DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-6900
Practice Address - Country:US
Practice Address - Phone:334-451-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1188537163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6636278OtherDRIVERS LICENSE