Healthcare Provider Details

I. General information

NPI: 1649804675
Provider Name (Legal Business Name): MEREDITH CHRYSTIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6338 US HIGHWAY 301 S
RIVERVIEW FL
33578-3829
US

IV. Provider business mailing address

12014 LEGACY BRIGHT ST
RIVERVIEW FL
33578-0002
US

V. Phone/Fax

Practice location:
  • Phone: 813-419-3386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: