Provider Demographics
NPI:1104711142
Name:DE LA ROSA, CRYSTAL (RN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 VICTORIA OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7587
Mailing Address - Country:US
Mailing Address - Phone:845-642-8507
Mailing Address - Fax:
Practice Address - Street 1:1845 HOLSONBACK DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5282
Practice Address - Country:US
Practice Address - Phone:386-547-2039
Practice Address - Fax:386-274-0518
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9578454163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health