Healthcare Provider Details

I. General information

NPI: 1265232037
Provider Name (Legal Business Name): CRYSTAL FAITH WEBSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 LITTLE RD
TRINITY FL
34655-1814
US

IV. Provider business mailing address

9930 JONAS SALK DR APT 312
RIVERVIEW FL
33578-7444
US

V. Phone/Fax

Practice location:
  • Phone: 727-848-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: