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NPI Code Detail

MEDICARE: ANGELA LYNN CRUM ARNP

MEDICARE: ANGELA LYNN CRUM 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
1363LF0000XFamily Nurse Practitioner9179486FL

General Provider Information

NPI Number : 1124156070
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA LYNN CRUM ARNP
Provider Business Mailing Address
First Line : PO BOX 61148
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32236-1148
Country : US
Telephone Number : 904-400-6105
Fax Number : 904-400-6102
Provider Business Practice Location Address
First Line : 6856 103RD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-6877
Country : US
Telephone Number : 904-777-0616
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 04/29/2011

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