1245763937 NPI number — CRYSTAL BROWN ARNP-C

Table of content: CRYSTAL BROWN ARNP-C (NPI 1245763937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245763937 NPI number — CRYSTAL BROWN ARNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
CRYSTAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245763937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 CITRONE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALRICO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33594-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-786-8024
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3433 LITHIA PINECREST RD STE 347
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALRICO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33596-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-578-4971
Provider Business Practice Location Address Fax Number:
813-726-0723
Provider Enumeration Date:
04/10/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  9214941 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)