Healthcare Provider Details

I. General information

NPI: 1962739813
Provider Name (Legal Business Name): KRYSTAL HALL MEDICAL PROFESSIONAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6984 PINE FOREST RD
PENSACOLA FL
32526-8908
US

IV. Provider business mailing address

38 S BLUE ANGEL PKWY # 104
PENSACOLA FL
32506-6045
US

V. Phone/Fax

Practice location:
  • Phone: 850-456-4082
  • Fax:
Mailing address:
  • Phone: 850-456-4082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3248772
License Number StateFL

VIII. Authorized Official

Name: MRS. KRYSTAL S HALL
Title or Position: NURSE PRACTITIONER
Credential: ARNP
Phone: 850-529-7932