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General NPI Number Information
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NPI Number | 1780731844
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Entity Type | Individual
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Provider Name | KERRY ANNE CRANDALL ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 266 N NOVA RD # 344
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5124
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Country | US
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Telephone | 386-852-8505
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Fax | 888-435-0422
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Provider Business Mailing Address
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Address Line | 75 KNOLLWOOD ESTATES DR
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City | ORMOND BEACH
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State | FL
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Zip | 32174-4220
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Country | US
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Telephone | 386-852-8505
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Fax | 386-677-5686
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | ARNP2043932
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License Number State | FL
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