Provider Demographics
NPI:1083670426
Name:MCCRAY, CRYSTAL S (RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:S
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:S
Other - Last Name:MCCRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:928 SAWGRASS ST
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-0210
Mailing Address - Country:US
Mailing Address - Phone:863-902-0037
Mailing Address - Fax:
Practice Address - Street 1:1100 S OLYMPIA ST
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-4400
Practice Address - Country:US
Practice Address - Phone:863-983-1408
Practice Address - Fax:863-983-1414
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9218935163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse