Healthcare Provider Details

I. General information

NPI: 1629796115
Provider Name (Legal Business Name): CRYSTAL JOHNSTON GARCIA MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 W LAKE MARY BLVD
LAKE MARY FL
32746-3315
US

IV. Provider business mailing address

2759 PALASTRO WAY
OCOEE FL
34761-5012
US

V. Phone/Fax

Practice location:
  • Phone: 407-332-7700
  • Fax: 407-332-9749
Mailing address:
  • Phone: 407-209-8832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11021469
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11021469
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: