Provider Demographics
NPI:1184391278
Name:CRONE, JENNY PHUONG
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:PHUONG
Last Name:CRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 S OSPREY AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2929
Mailing Address - Country:US
Mailing Address - Phone:941-917-2678
Mailing Address - Fax:941-917-2661
Practice Address - Street 1:1625 S OSPREY AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2929
Practice Address - Country:US
Practice Address - Phone:941-917-2678
Practice Address - Fax:941-917-2661
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG165300363LP0808X
FL11015078363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health