Provider Demographics
NPI:1043995152
Name:HERNANDEZ, CRYSTAL (CRPS)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CRPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 12TH ST # 102
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-3713
Mailing Address - Country:US
Mailing Address - Phone:321-697-8232
Mailing Address - Fax:
Practice Address - Street 1:3113 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6501
Practice Address - Country:US
Practice Address - Phone:407-892-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRPS100367.A175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist