Healthcare Provider Details

I. General information

NPI: 1467391144
Provider Name (Legal Business Name): CROWN RESTORATION PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 NW 19TH AVE
CAPE CORAL FL
33993-3931
US

IV. Provider business mailing address

2904 NW 19TH AVE
CAPE CORAL FL
33993-3931
US

V. Phone/Fax

Practice location:
  • Phone: 239-365-3505
  • Fax:
Mailing address:
  • Phone: 239-365-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JASMINE WILLIAMS
Title or Position: MANAGING MEMBER
Credential:
Phone: 239-324-8036