Provider Demographics
NPI:1578859252
Name:CRANDALL, JACQUELINE BETH (APRN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BETH
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:BETH
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:400 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5519
Mailing Address - Country:US
Mailing Address - Phone:239-649-3313
Mailing Address - Fax:239-261-4475
Practice Address - Street 1:400 8TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102
Practice Address - Country:US
Practice Address - Phone:239-649-3313
Practice Address - Fax:239-261-4475
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9217974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily