Provider Demographics
NPI:1760951990
Name:TAPIA, KRYSTAL MAREE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:MAREE
Last Name:TAPIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12246 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7016
Mailing Address - Country:US
Mailing Address - Phone:954-517-8933
Mailing Address - Fax:
Practice Address - Street 1:12246 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7016
Practice Address - Country:US
Practice Address - Phone:954-517-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA14978OtherFLORIDA LICENSE