Provider Demographics
NPI:1750750790
Name:CROWLEY, NICCOLE RENEA (F-NP)
Entity type:Individual
Prefix:
First Name:NICCOLE
Middle Name:RENEA
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:F-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-4410
Mailing Address - Country:US
Mailing Address - Phone:931-483-2500
Mailing Address - Fax:931-486-3748
Practice Address - Street 1:5421 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-4410
Practice Address - Country:US
Practice Address - Phone:931-486-2500
Practice Address - Fax:931-486-3748
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily