Healthcare Provider Details

I. General information

NPI: 1760611537
Provider Name (Legal Business Name): CRYSTAL ANN HYDER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD FLAGLER HOSPITAL
ST. AUGUSTINE FL
32086
US

IV. Provider business mailing address

3145 COASTAL HWY UNIT 1158
ST AUGUSTINE FL
32084-2210
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-5155
  • Fax:
Mailing address:
  • Phone: 904-826-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3359852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: