Provider Demographics
NPI:1538874334
Name:CROUCH, PAGE TENILE (FNP)
Entity type:Individual
Prefix:
First Name:PAGE
Middle Name:TENILE
Last Name:CROUCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-6416
Mailing Address - Country:US
Mailing Address - Phone:512-567-8461
Mailing Address - Fax:
Practice Address - Street 1:4208 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-6416
Practice Address - Country:US
Practice Address - Phone:512-567-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1095305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily