Healthcare Provider Details

I. General information

NPI: 1093622243
Provider Name (Legal Business Name): CRYSTAL'S SKIN & BEAUTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 W BEARSS AVE
TAMPA FL
33618-2100
US

IV. Provider business mailing address

3355 W BEARSS AVE
TAMPA FL
33618-2100
US

V. Phone/Fax

Practice location:
  • Phone: 813-692-6366
  • Fax:
Mailing address:
  • Phone: 813-692-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CRYSTAL WALKER
Title or Position: OWNER/DUAL LICENSE SPECIALIST
Credential: CPE, FS
Phone: 813-692-6366