Healthcare Provider Details

I. General information

NPI: 1538905237
Provider Name (Legal Business Name): SARAH NICOLE CRUMB APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13403 BOYETTE RD
RIVERVIEW FL
33569-8742
US

IV. Provider business mailing address

13403 BOYETTE RD
RIVERVIEW FL
33569-8742
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-1775
  • Fax: 813-651-9082
Mailing address:
  • Phone: 813-654-1775
  • Fax: 813-651-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: