Provider Demographics
NPI:1568029130
Name:RODGERS, CRYSTAL JOY
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JOY
Last Name:RODGERS
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 1:700 TANGERINE DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-9348
Mailing Address - Country:US
Mailing Address - Phone:863-287-1519
Mailing Address - Fax:
Practice Address - Street 1:700 TANGERINE DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-9348
Practice Address - Country:US
Practice Address - Phone:863-287-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL19000127801343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)