Provider Demographics
NPI:1356164073
Name:CROVADOR, MARIANA (FNP-C)
Entity type:Individual
Prefix:MS
First Name:MARIANA
Middle Name:
Last Name:CROVADOR
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 1:9 MULE RD. PINNACLE UROLOGY
Mailing Address - Street 2:SUITE E-5
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-230-2661
Mailing Address - Fax:732-383-8149
Practice Address - Street 1:9 MULE RD. PINNACLE UROLOGY
Practice Address - Street 2:SUITE E-5
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-230-2661
Practice Address - Fax:732-383-8149
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15156400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology