Healthcare Provider Details

I. General information

NPI: 1588528640
Provider Name (Legal Business Name): CRYSTAL LADONNA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 AUSTIN DAVIS AVE STE 110
TALLAHASSEE FL
32308-7408
US

IV. Provider business mailing address

52 EVERGREEN DR
CRAWFORDVILLE FL
32327-3042
US

V. Phone/Fax

Practice location:
  • Phone: 850-524-0377
  • Fax:
Mailing address:
  • Phone: 850-524-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number240775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: