Healthcare Provider Details

I. General information

NPI: 1023626561
Provider Name (Legal Business Name): CREDENTIALING CONSULTANTS OF FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 ALABASTER CV
SANFORD FL
32771-3607
US

IV. Provider business mailing address

1003 ALABASTER CV
SANFORD FL
32771-3607
US

V. Phone/Fax

Practice location:
  • Phone: 321-710-7747
  • Fax: 877-797-2707
Mailing address:
  • Phone: 321-710-7747
  • Fax: 877-797-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MELISSA OWEN NORRIS
Title or Position: CEO
Credential:
Phone: 321-710-7747