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General NPI Number Information
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NPI Number | 1518632553
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Entity Type | Individual
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Provider Name | CRYSTAL LYNN LANDGRAF FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 442 SPANISHWOODS DR
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City | ROCKPORT
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State | TX
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Zip | 78382-9662
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Country | US
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Telephone | 361-205-2205
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 192
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City | INGLESIDE
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State | TX
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Zip | 78362-0192
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Country | US
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Telephone | 361-205-2205
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1049983
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License Number State | TX
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