Healthcare Provider Details

I. General information

NPI: 1215103882
Provider Name (Legal Business Name): CRYSTAL BREEZE CULLEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 N MAIN ST
BELL FL
32619-4713
US

IV. Provider business mailing address

23343 NW COUNTY ROAD 236
HIGH SPRINGS FL
32643-9669
US

V. Phone/Fax

Practice location:
  • Phone: 352-463-1100
  • Fax: 352-463-4507
Mailing address:
  • Phone: 352-463-2374
  • Fax: 352-463-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9219280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: