Healthcare Provider Details

I. General information

NPI: 1073449807
Provider Name (Legal Business Name): CRYSTAL MOTAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 SW 73RD AVE
NORTH LAUDERDALE FL
33068-3656
US

IV. Provider business mailing address

1121 SW 73RD AVE
NORTH LAUDERDALE FL
33068-3656
US

V. Phone/Fax

Practice location:
  • Phone: 954-907-9039
  • Fax:
Mailing address:
  • Phone: 954-907-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9359474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: