Provider Demographics
NPI:1720780901
Name:CROWNSNCLAWS LLC
Entity Type:Organization
Organization Name:CROWNSNCLAWS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAKEITA
Authorized Official - Middle Name:VINNIE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-753-2413
Mailing Address - Street 1:19046 BRUCE B DOWNS BLVD # 1042
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2434
Mailing Address - Country:US
Mailing Address - Phone:813-753-2413
Mailing Address - Fax:813-910-9049
Practice Address - Street 1:4626 ASHBURN SQUARE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-5956
Practice Address - Country:US
Practice Address - Phone:813-753-2413
Practice Address - Fax:813-910-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier