Healthcare Provider Details

I. General information

NPI: 1689126609
Provider Name (Legal Business Name): MRS. BRANDY LYNN CRISPINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANDY LYNN EISNER

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 NE 4TH ST
POMPANO BEACH FL
33060-6416
US

IV. Provider business mailing address

1331 N 69TH AVE
HOLLYWOOD FL
33024
US

V. Phone/Fax

Practice location:
  • Phone: 954-212-9126
  • Fax:
Mailing address:
  • Phone: 954-999-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12366120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: