Individual provider Active NPI

Brittany Gardner McCroan, APRN

  • Nurse Practitioner
  • Port St Joe, FL
National Provider Identifier
1598326332
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN11002811 Issued in FL
Practice address
101 Good Morning St Ste 109B
Port St Joe, FL 32456-4765
Phone
(850) 357-8192
Fax
(850) 659-9565
NPI assigned
Jun 24, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN11002811 FL Primary

Addresses

Primary practice location

101 Good Morning St Ste 109B
Port St Joe, FL 32456-4765

Mailing address

204 Coral Dr
Port Saint Joe, FL 32456-6257
Phone (850) 865-3471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190829001373 FL Practitioner - Nurse Practitioner 8628306610 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11002811FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Salt and Ivy Gulf LLC CurrentSince Mar 24, 2024 Accepting new patients
Chipola Medical Associates, LLC CurrentSince Aug 31, 2020 Accepting new patients

Locations

4215 Kelson Ave
Marianna, FL 32446
Phone (850) 526-3434

2475 Garrison Ave
Port St Joe, FL 32456
Phone (850) 227-1276

101 Good Morning St
Ste 109B
Port St Joe, FL 32456
Phone (850) 357-8192

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1598326332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 CORAL DR",
            "city": "PORT SAINT JOE",
            "state": "FL",
            "postal_code": "324566257",
            "telephone_number": "850-865-3471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 GOOD MORNING ST STE 109B",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324564765",
            "telephone_number": "850-357-8192",
            "fax_number": "850-659-9565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCROAN",
        "first_name": "BRITTANY",
        "middle_name": "GARDNER",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-24",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11002811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Joe, FL

Sources for this page

Verify at the official NPI Registry.