Healthcare Provider Details

I. General information

NPI: 1356857536
Provider Name (Legal Business Name): JEWELIAN CROSSLEY CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2017
Last Update Date: 12/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 NE 8TH AVE
OAKLAND PARK FL
33334-3215
US

IV. Provider business mailing address

5260 NW 88TH AVE
SUNRISE FL
33351-4895
US

V. Phone/Fax

Practice location:
  • Phone: 954-547-7180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: