Healthcare Provider Details

I. General information

NPI: 1003723024
Provider Name (Legal Business Name): CRYSTAL DAWN PERNA AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 PARK ST
HYANNIS MA
02601-5206
US

IV. Provider business mailing address

52 PARK ST
HYANNIS MA
02601-5206
US

V. Phone/Fax

Practice location:
  • Phone: 508-771-4205
  • Fax: 508-771-7870
Mailing address:
  • Phone: 508-771-4205
  • Fax: 508-771-7870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2261182
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: