MEDICARE: SELENA CRANDALL ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9238210	FL
2	363L00000X	Nurse Practitioner	APRN9238210	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043635675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA CRANDALL ARNP

Provider Business Mailing Address
First Line	:	38135 MARKET SQ
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-7505
Country	:	US
Telephone Number	:	813-528-4975
Fax Number	:

Provider Business Practice Location Address
First Line	:	3860 SUN CITY CENTER BLVD
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-6806
Country	:	US
Telephone Number	:	813-633-1980
Fax Number	:	813-355-5104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	09/21/2023

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