Provider Demographics
NPI:1467259317
Name:WOODEN, CRYSTAL M
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:WOODEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W ATLANTIC AVE STE O5
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3686
Mailing Address - Country:US
Mailing Address - Phone:561-648-0783
Mailing Address - Fax:
Practice Address - Street 1:301 W ATLANTIC AVE STE O5
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3686
Practice Address - Country:US
Practice Address - Phone:561-648-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 171M00000X, 372600000X, 376J00000X
FLCNA199027376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker