Provider Demographics
NPI:1053167734
Name:CROATAN FAMILY MEDICINE, P.C.
Entity type:Organization
Organization Name:CROATAN FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NEEDS DEMARTINO
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-873-7044
Mailing Address - Street 1:PO BOX 1776
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-1776
Mailing Address - Country:US
Mailing Address - Phone:252-423-4300
Mailing Address - Fax:252-862-2684
Practice Address - Street 1:2917 S CROATAN HWY
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9027
Practice Address - Country:US
Practice Address - Phone:954-873-7044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care