Provider Demographics
NPI:1063850378
Name:GILL, CHRYSTAL (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W AVENUE M4
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1432
Mailing Address - Country:US
Mailing Address - Phone:661-480-2377
Mailing Address - Fax:
Practice Address - Street 1:1120 W AVENUE M4
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1432
Practice Address - Country:US
Practice Address - Phone:818-621-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-08
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338670363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03948634Medicaid
NYJ400186277Medicare PIN