MEDICARE: CRYSTAL MARIE NAVARRO 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
1	163W00000X	Registered Nurse	636351	NY
2	363LF0000X	Family Nurse Practitioner	348833	NY

General Provider Information

NPI Number	:	1295167872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MARIE NAVARRO FNP

Provider Business Mailing Address
First Line	:	1715 UNIVERSITY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-6961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 UNIVERSITY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-6961
Country	:	US
Telephone Number	:	718-294-0700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	12/06/2021

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