Healthcare Provider Details

I. General information

NPI: 1497675508
Provider Name (Legal Business Name): CRYSTAL CARRILLO APRN, FNP-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6329 STATE ROAD 54
NEW PORT RICHEY FL
34653-6037
US

IV. Provider business mailing address

6436 PROPEL RUN
NEW PORT RICHEY FL
34655-1029
US

V. Phone/Fax

Practice location:
  • Phone: 727-844-5555
  • Fax:
Mailing address:
  • Phone: 913-952-6231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: