Provider Demographics
NPI:1669799615
Name:CROAN, DEBORAH LYNN (FNP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LYNN
Last Name:CROAN
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 1:4800 MAGNOLIA AVE
Mailing Address - Street 2:ATTN: STUDENT HEALTH
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1201
Mailing Address - Country:US
Mailing Address - Phone:951-222-8150
Mailing Address - Fax:
Practice Address - Street 1:4800 MAGNOLIA AVE
Practice Address - Street 2:ATTN: STUDENT HEALTH
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1201
Practice Address - Country:US
Practice Address - Phone:951-222-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily