Provider Demographics
NPI:1578227831
Name:CROOKS, DENETRA NEKIA
Entity type:Individual
Prefix:
First Name:DENETRA
Middle Name:NEKIA
Last Name:CROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENETRA
Other - Middle Name:NEKIA
Other - Last Name:AARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 W STATE ROAD 436 STE 2039
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3053
Mailing Address - Country:US
Mailing Address - Phone:321-304-7170
Mailing Address - Fax:
Practice Address - Street 1:801 W STATE ROAD 436 STE 2039
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3053
Practice Address - Country:US
Practice Address - Phone:321-304-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 376J00000X, 3747P1801X
FL185571376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113940400Medicaid