=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669236758
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRYSTAL ALLISON LOCKE APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2024
-----------------------------------------------------
Last Update Date | 04/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1850 SW FOUNTAINVIEW BLVD
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34986-3443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-336-2818
-----------------------------------------------------
Fax | 772-336-5313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 S PINE ISLAND RD STE 800
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-3923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-336-2818
-----------------------------------------------------
Fax | 772-336-5313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN11031142
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11031142
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------