Healthcare Provider Details

I. General information

NPI: 1154142651
Provider Name (Legal Business Name): CRYSTAL M CUETO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WESTMINSTER ST N STE A
LEHIGH ACRES FL
33936-6518
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 239-368-1808
  • Fax: 239-368-4664
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-368-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11035882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: