Healthcare Provider Details

I. General information

NPI: 1750168423
Provider Name (Legal Business Name): KRYSTAL MARY AGOSTO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2, KM. 80.4 BARRIO SAN DANIEL SECTOR LAS CANELAS
ARECIBO PR
00614-4050
US

IV. Provider business mailing address

CARRETERA #2, KM. 80.4 BARRIO SAN DANIEL SECTOR LAS CANELAS
ARECIBO PR
00614-4050
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-5475
  • Fax: 787-880-1624
Mailing address:
  • Phone: 787-878-5475
  • Fax: 787-880-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11037014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: