Provider Demographics
NPI:1477302701
Name:LLANUSA, CHRYSTAL (APRN)
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:LLANUSA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW 118TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1600
Mailing Address - Country:US
Mailing Address - Phone:954-552-0929
Mailing Address - Fax:
Practice Address - Street 1:3181 SW 118TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-1600
Practice Address - Country:US
Practice Address - Phone:954-916-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1032800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner