Provider Demographics
NPI:1669751459
Name:MCCRARY, CRYSTAL L (ARNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 MALVERNS LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6026
Mailing Address - Country:US
Mailing Address - Phone:772-359-2441
Mailing Address - Fax:
Practice Address - Street 1:725 PRIMERA BLVD
Practice Address - Street 2:STE.220
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2125
Practice Address - Country:US
Practice Address - Phone:407-562-1885
Practice Address - Fax:407-672-0440
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9246732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16699751459Medicaid
FLFS136ZMedicare PIN