Healthcare Provider Details

I. General information

NPI: 1851211502
Provider Name (Legal Business Name): CRYSTAL WHITTAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 NW 39TH AVE STE 130-1020
GAINESVILLE FL
32606-7331
US

IV. Provider business mailing address

9200 NW 39TH AVE STE 1301020L
GAINESVILLE FL
32606-7331
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 316-617-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: