Healthcare Provider Details

I. General information

NPI: 1821616376
Provider Name (Legal Business Name): CRYSTAL BURKS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL BURKS RN

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 TREEMONTE DR STE 258
ORANGE CITY FL
32763-7945
US

IV. Provider business mailing address

258 TREEMONTE DR STE 258
ORANGE CITY FL
32763-7945
US

V. Phone/Fax

Practice location:
  • Phone: 386-628-3376
  • Fax:
Mailing address:
  • Phone: 386-628-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007710
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberAPRN11007710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: