Healthcare Provider Details

I. General information

NPI: 1346954096
Provider Name (Legal Business Name): CRYSTAL CATHERINE POMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 VONDERBURG DR
BRANDON FL
33511-5972
US

IV. Provider business mailing address

615 VONDERBURG DR
BRANDON FL
33511-5972
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-6200
  • Fax:
Mailing address:
  • Phone: 813-662-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: