Provider Demographics
NPI:1871267211
Name:CROCKER, LAUREN NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:CROCKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7429 CARATOKE HWY
Mailing Address - Street 2:
Mailing Address - City:JARVISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27947-9708
Mailing Address - Country:US
Mailing Address - Phone:252-491-2111
Mailing Address - Fax:
Practice Address - Street 1:7429 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:JARVISBURG
Practice Address - State:NC
Practice Address - Zip Code:27947-9708
Practice Address - Country:US
Practice Address - Phone:252-491-2111
Practice Address - Fax:855-246-2133
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily