Healthcare Provider Details

I. General information

NPI: 1568212744
Provider Name (Legal Business Name): CRNP INTEGRATED WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 N UNIVERSITY DR PMB 3000
CORAL SPRINGS FL
33071-6134
US

IV. Provider business mailing address

2139 N UNIVERSITY DR. PMB 3000
CORAL SPRINGS FL
33071
US

V. Phone/Fax

Practice location:
  • Phone: 954-795-6766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CANDICE REYNOLDS
Title or Position: MANAGER
Credential: FNP-C, PMHNP-BC
Phone: 954-795-6766