Provider Demographics
NPI:1861828592
Name:WARNER, CRYSTAL (CSA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3203 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2782
Mailing Address - Country:US
Mailing Address - Phone:850-677-8607
Mailing Address - Fax:
Practice Address - Street 1:3203 CORNELL DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-2782
Practice Address - Country:US
Practice Address - Phone:850-677-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist