Healthcare Provider Details

I. General information

NPI: 1982255352
Provider Name (Legal Business Name): CRYSTAL L GAZDA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL L HUBBELL

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 CRAWFORD AVE
GRANBURY TX
76048
US

IV. Provider business mailing address

1411 CRAWFORD AVE
GRANBURY TX
76048
US

V. Phone/Fax

Practice location:
  • Phone: 817-573-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax: 817-573-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1157504
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: