Healthcare Provider Details

I. General information

NPI: 1174384879
Provider Name (Legal Business Name): CRYSTAL LYNN HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 EXCHANGE CT STE 185
BOCA RATON FL
33431-4000
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 185
BOCA RATON FL
33431-4000
US

V. Phone/Fax

Practice location:
  • Phone: 877-345-5300
  • Fax: 561-989-3665
Mailing address:
  • Phone: 877-345-5300
  • Fax: 561-989-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13893
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: