Healthcare Provider Details

I. General information

NPI: 1922770403
Provider Name (Legal Business Name): JUSTIN AARON CRUTCHFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 1ST AVE
OCALA FL
34471-6504
US

IV. Provider business mailing address

332 OAKRIDGE LN
LONGVIEW TX
75605-5956
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7283
  • Fax: 407-303-0473
Mailing address:
  • Phone: 903-424-8324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1056094
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11048552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: