Provider Demographics
NPI:1922040690
Name:MARRETTA, MAXINE CRAWLEY (ARNP-C)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:CRAWLEY
Last Name:MARRETTA
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 DOWNING DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-1860
Mailing Address - Country:US
Mailing Address - Phone:850-912-2500
Mailing Address - Fax:
Practice Address - Street 1:790 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-1000
Practice Address - Country:US
Practice Address - Phone:850-912-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3084532363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health