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General NPI Number Information
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NPI Number | 1053361956
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Entity Type | Individual
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Provider Name | MARY ANN CRUMLISH PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 2744 GULF BREEZE PARKWAY
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City | GULF BREEZE
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State | FL
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Zip | 32563-2908
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Country | US
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Telephone | 850-934-5713
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Fax | 850-934-0379
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Provider Business Mailing Address
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Address Line | 2744 GULF BREEZE PARKWAY
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City | GULF BREEZE
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State | FL
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Zip | 32563-3091
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Country | US
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Telephone | 850-934-5713
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Fax | 850-934-0379
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9102271
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License Number State | FL
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