Provider Demographics
NPI:1093109886
Name:PAPAK, CRYSTAL (ARNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PAPAK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 33RD ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-1506
Mailing Address - Country:US
Mailing Address - Phone:727-525-0006
Mailing Address - Fax:727-521-3694
Practice Address - Street 1:3745 33RD ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-1506
Practice Address - Country:US
Practice Address - Phone:727-525-0006
Practice Address - Fax:727-521-3694
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9302183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014715700Medicaid