Provider Demographics
NPI:1912436684
Name:CROMER, CARLYN (FNP)
Entity Type:Individual
Prefix:
First Name:CARLYN
Middle Name:
Last Name:CROMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CARLYN
Other - Middle Name:
Other - Last Name:CUSACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 WSW LOOP 323 STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4809 OLD BULLARD RD STE 500
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1248
Practice Address - Country:US
Practice Address - Phone:903-579-7261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily