MEDICARE: MS. CRYSTAL M CARBAJAL FNP

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	AP124964	TX

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
2	341369YLPS	OTHER	TX	WELLMED PTAN

General Provider Information

NPI Number	:	1366878043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL M CARBAJAL FNP

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	844-630-0700
Fax Number	:	877-374-1924

Provider Business Practice Location Address
First Line	:	1211 E CLIFF DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4734
Country	:	US
Telephone Number	:	155-916-2269
Fax Number	:	915-308-9433

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

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	09/19/2023

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