Provider Demographics
NPI:1942660774
Name:JOHNSON-OPOKU, CRYSTAL RICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RICHELLE
Last Name:JOHNSON-OPOKU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8870 PEBBLEBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-1319
Mailing Address - Country:US
Mailing Address - Phone:863-397-6322
Mailing Address - Fax:
Practice Address - Street 1:8870 PEBBLEBROOKE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-1319
Practice Address - Country:US
Practice Address - Phone:863-397-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9304537163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse