Provider Demographics
NPI:1730356494
Name:CROOKS, LISA CHERYL (RN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:CHERYL
Last Name:CROOKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1728
Mailing Address - Street 2:118 WOODLAND LANE
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-1728
Mailing Address - Country:US
Mailing Address - Phone:352-262-2623
Mailing Address - Fax:
Practice Address - Street 1:801 SW SECOND AVENUE
Practice Address - Street 2:SHANDS AT AGH 3IMC
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6289
Practice Address - Country:US
Practice Address - Phone:352-733-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9201352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN 9201352OtherRN LICENSE