=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174404263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVIDAIL HEALTH GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7901 4TH ST N STE 300
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33702-4399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-701-8347
-----------------------------------------------------
Fax | 505-305-2257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 OLD KINGS RD N STE 123
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32137-4603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-701-8347
-----------------------------------------------------
Fax | 505-305-2257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. VIKAS CRAWFORD
-----------------------------------------------------
Credential | DNP, APRN, FNP-C
-----------------------------------------------------
Telephone | 904-701-8347
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------