Healthcare Provider Details

I. General information

NPI: 1063482826
Provider Name (Legal Business Name): DAVID RAYMOND CRUMBLEY MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

5350 STAFFORD CIR
PACE FL
32571-6816
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6517
  • Fax: 850-505-6548
Mailing address:
  • Phone: 850-505-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR 75417
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN106195
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: