1396149530 NPI number — MRS. CRYSTLE DANIELA JONES PA-C

Table of content: MRS. CRYSTLE DANIELA JONES PA-C (NPI 1396149530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396149530 NPI number — MRS. CRYSTLE DANIELA JONES PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
CRYSTLE
Provider Middle Name:
DANIELA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELLIS
Provider Other First Name:
CRYSTLE
Provider Other Middle Name:
DANIELA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396149530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7070 GRELOT RD APT 326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36695-2645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-602-0485
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 BELLEVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36426-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-602-0485
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2014

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: 363A00000X , with the licence number:  PA.1004 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com