Provider Demographics
NPI:1902374002
Name:CROWTHER, RALPH MICHAEL (APRN)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:MICHAEL
Last Name:CROWTHER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:RALPH
Other - Middle Name:MICHAEL
Other - Last Name:CROWTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1492 APPLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-8085
Mailing Address - Country:US
Mailing Address - Phone:850-264-7726
Mailing Address - Fax:
Practice Address - Street 1:1492 APPLEWOOD WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-8085
Practice Address - Country:US
Practice Address - Phone:850-264-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily