MEDICARE: CRYSTAL ALLEN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11004479	FL

General Provider Information

NPI Number	:	1316598717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL ALLEN

Provider Business Mailing Address
First Line	:	12397 S ORANGE BLOSSOM TRL STE 21
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-6217
Country	:	US
Telephone Number	:	786-707-5166
Fax Number	:

Provider Business Practice Location Address
First Line	:	12397 S ORANGE BLOSSOM TRL STE 21
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-6217
Country	:	US
Telephone Number	:	786-707-5166
Fax Number	:

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

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	06/19/2026

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Directions to “ CRYSTAL ALLEN ” Practice Location

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