| NPI | 1104309681 |
|---|---|
| Former Name | JACQUELINE CAROL CROCKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN24531) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN176793) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2021-07-02 |