Healthcare Provider Details

I. General information

NPI: 1265360713
Provider Name (Legal Business Name): ANGELA D CRUSE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 UNITY TREE DR
EDGEWATER FL
32141-6414
US

IV. Provider business mailing address

3208 UNITY TREE DR
EDGEWATER FL
32141-6414
US

V. Phone/Fax

Practice location:
  • Phone: 386-690-1970
  • Fax:
Mailing address:
  • Phone: 386-690-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5186209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: