Individual
JENNIFER LYNN CROCKFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6161 KEMPSVILLE CLRCLE, STE 225, NORFOLK, VA 23502
(757) 455-6368
(757) 455-6686
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 686-3542
(757) 686-0230
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024 069161
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77933424
—
VA
Enumeration date
06/13/2005
Last updated
07/08/2007
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