Provider Demographics
NPI:1457635419
Name:CRANDLLE, MARK (CNA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:CRANDLLE
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 COUNTRY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4904
Mailing Address - Country:US
Mailing Address - Phone:904-437-6875
Mailing Address - Fax:
Practice Address - Street 1:4009 COUNTRY MEADOWS DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4904
Practice Address - Country:US
Practice Address - Phone:904-437-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA218713376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide