Healthcare Provider Details

I. General information

NPI: 1881414183
Provider Name (Legal Business Name): CRYSTAL ELIZABETH THOMAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 AVENUE O
RIVIERA BEACH FL
33404-7217
US

IV. Provider business mailing address

291 AVENUE O
RIVIERA BEACH FL
33404-7217
US

V. Phone/Fax

Practice location:
  • Phone: 561-631-5102
  • Fax:
Mailing address:
  • Phone: 561-631-5102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11049233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: