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NPI Code Detail

MEDICARE: CHANCELLOR CRUMP

MEDICARE: CHANCELLOR CRUMP
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1528997350
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANCELLOR CRUMP
Provider Business Mailing Address
First Line : 507- N22ND STREET
Second Line :
City : TAMPA
State : FL
Zip : 33610-4350
Country : US
Telephone Number : 813-239-8069
Fax Number :
Provider Business Practice Location Address
First Line : 507- N22ND STREET
Second Line :
City : TAMPA
State : FL
Zip : 33610-4350
Country : US
Telephone Number : 813-239-8069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2026
Last Update Date : 05/18/2026

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Directions to “ CHANCELLOR CRUMP ” Practice Location

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