Provider Demographics
NPI:1154847002
Name:WATSON, CRYSTAL A
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 GREEN PINE BLVD APT H1
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7082
Mailing Address - Country:US
Mailing Address - Phone:561-689-6036
Mailing Address - Fax:561-689-6036
Practice Address - Street 1:1113 GREEN PINE BLVD APT H1
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-7082
Practice Address - Country:US
Practice Address - Phone:561-689-6036
Practice Address - Fax:561-689-6036
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other