Provider Demographics
NPI:1063482826
Name:CRUMBLEY, DAVID RAYMOND (MSN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RAYMOND
Last Name:CRUMBLEY
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 STAFFORD CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-6816
Mailing Address - Country:US
Mailing Address - Phone:850-505-6517
Mailing Address - Fax:
Practice Address - Street 1:6000 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0001
Practice Address - Country:US
Practice Address - Phone:850-505-6517
Practice Address - Fax:850-505-6548
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR 75417163WW0000X
GARN106195163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WW0000XNursing Service ProvidersRegistered NurseWound Care