Provider Demographics
NPI:1639737026
Name:SPEARS, CHRISTAL ELISE
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:ELISE
Last Name:SPEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRISTAL
Other - Middle Name:ELISE
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHITE
Mailing Address - Street 1:3365 BURNS RD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4326
Mailing Address - Country:US
Mailing Address - Phone:561-775-1064
Mailing Address - Fax:
Practice Address - Street 1:3365 BURNS RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4326
Practice Address - Country:US
Practice Address - Phone:561-775-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily