Provider Demographics
NPI:1336288760
Name:CRANDALL, VIRGINIA L J (RN)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:L J
Last Name:CRANDALL
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 1:7551 FOREST OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-2437
Mailing Address - Country:US
Mailing Address - Phone:352-540-3812
Mailing Address - Fax:352-688-5097
Practice Address - Street 1:7551 FOREST OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2437
Practice Address - Country:US
Practice Address - Phone:352-540-3812
Practice Address - Fax:352-688-5097
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1866392163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL310493100Medicaid