Provider Demographics
NPI:1821616376
Name:BURKS, CRYSTAL (APRN)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:BURKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:BURKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:258 TREEMONTE DR STE 258
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7945
Mailing Address - Country:US
Mailing Address - Phone:386-628-3376
Mailing Address - Fax:
Practice Address - Street 1:258 TREEMONTE DR STE 258
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7945
Practice Address - Country:US
Practice Address - Phone:386-628-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007710207N00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty