Healthcare Provider Details

I. General information

NPI: 1942134994
Provider Name (Legal Business Name): CRYSTAL REANNA IRVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL REANNA PERRYMAN

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 N MAIN ST
BELL FL
32619-4713
US

IV. Provider business mailing address

2435 NW 45TH AVE
BELL FL
32619-3227
US

V. Phone/Fax

Practice location:
  • Phone: 352-681-2895
  • Fax:
Mailing address:
  • Phone: 352-681-2895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9431189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: