Provider Demographics
NPI: | 1851842710 |
---|---|
Name: | CRABTREE, MEREDITH (FNP-BC) |
Entity Type: | Individual |
Prefix: | |
First Name: | MEREDITH |
Middle Name: | |
Last Name: | CRABTREE |
Suffix: | |
Gender: | F |
Credentials: | FNP-BC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 11645 BISCAYNE BLVD |
Mailing Address - Street 2: | SUITE 308 |
Mailing Address - City: | NORTH MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33181-3155 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-538-8835 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11645 BISCAYNE BLVD |
Practice Address - Street 2: | SUITE 207 |
Practice Address - City: | NORTH MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33181-3155 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-297-9229 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2016-10-17 |
Last Update Date: | 2021-04-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 272249 | 363LA2200X |
FL | 9438070 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 019168000 | Medicaid |