Healthcare Provider Details

I. General information

NPI: 1275945305
Provider Name (Legal Business Name): JACQUELYN FARYN CREWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5528 NW 43RD ST
GAINESVILLE FL
32653-3301
US

IV. Provider business mailing address

1699 SW 16TH AVE
GAINESVILLE FL
32608-1158
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-3604
  • Fax: 352-627-4892
Mailing address:
  • Phone: 352-265-3604
  • Fax: 352-627-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number131145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: