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NPI Code Detail

MEDICARE: CRYSTAL A CISZEK FNP

MEDICARE: CRYSTAL A CISZEK FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN209456GA
2363LF0000XFamily Nurse Practitioner11020853FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124486089
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL A CISZEK FNP
Provider Business Mailing Address
First Line : 463688 STATE ROAD 200, STE 1
Second Line : #364
City : YULEE
State : FL
Zip : 32097-0304
Country : US
Telephone Number : 478-290-0677
Fax Number :
Provider Business Practice Location Address
First Line : 10752 DEERWOOD PARK BLVD STE 100
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4846
Country : US
Telephone Number : 478-290-0677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2016
Last Update Date : 09/05/2022

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