Provider Demographics
NPI:1548993744
Name:CRENSHAW, OCTAVIA (MSN APRN FNP-C)
Entity type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:MSN APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E BROAD ST UNIT 887
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-5235
Mailing Address - Country:US
Mailing Address - Phone:614-286-8864
Mailing Address - Fax:
Practice Address - Street 1:2973 TAYLOR ROAD EXT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9483
Practice Address - Country:US
Practice Address - Phone:380-204-7713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily