MEDICARE: CRYSTAL JOERG

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	1041C0700X	Clinical Social Worker	SW25949	FL

General Provider Information

NPI Number	:	1669252409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL JOERG

Provider Business Mailing Address
First Line	:	5331 PRIMROSE LAKE CIR STE 118
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3597
Country	:	US
Telephone Number	:	813-309-8424
Fax Number	:

Provider Business Practice Location Address
First Line	:	5331 PRIMROSE LAKE CIR STE 118
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3749
Country	:	US
Telephone Number	:	813-309-8424
Fax Number	:

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

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	01/09/2026

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Directions to “ CRYSTAL JOERG ” Practice Location

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