Provider Demographics
NPI:1659839579
Name:LINN, CRYSTAL GAIL (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GAIL
Last Name:LINN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHRYSTAL
Other - Middle Name:GAIL
Other - Last Name:AULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-361-5534
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:220 N SYKES CREEK PKWY STE 301
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3490
Practice Address - Country:US
Practice Address - Phone:321-361-5534
Practice Address - Fax:321-361-5543
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLW950OtherMEDICARE