Healthcare Provider Details

I. General information

NPI: 1891260220
Provider Name (Legal Business Name): CRYSTAL NICOLE HAYS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CLYDE MORRIS BLVD # 20
PORT ORANGE FL
32129-5220
US

IV. Provider business mailing address

4601 CLYDE MORRIS BLVD # 20
PORT ORANGE FL
32129-5220
US

V. Phone/Fax

Practice location:
  • Phone: 678-572-3570
  • Fax:
Mailing address:
  • Phone: 678-572-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9355203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: