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General NPI Number Information
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NPI Number | 1619491206
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Entity Type | Individual
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Provider Name | CRYSTAL OSBORN
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Gender | Female
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 200 CENTRAL AVE # 36
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City | SARASOTA
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State | FL
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Zip | 34236-4914
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Country | US
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Telephone | 949-480-7590
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 MIDNIGHT PEARL DR
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City | SARASOTA
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State | FL
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Zip | 34240-2418
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Country | US
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Telephone | 949-941-7358
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 54557
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 9112961
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License Number State | FL
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