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NPI Code Detail

MEDICARE: CRYSTAL MARIE PENA NP

MEDICARE: CRYSTAL MARIE PENA NP
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 Practitioner1090349TX

General Provider Information

NPI Number : 1841917085
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL MARIE PENA NP
Provider Business Mailing Address
First Line : 5224 75TH ST STE D
Second Line :
City : LUBBOCK
State : TX
Zip : 79424-2525
Country : US
Telephone Number : 806-712-1096
Fax Number : 806-771-2093
Provider Business Practice Location Address
First Line : 345 S WATER ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78401-2819
Country : US
Telephone Number : 361-500-0660
Fax Number : 201-812-7729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2022
Last Update Date : 01/29/2026

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Directions to “ CRYSTAL MARIE PENA NP” Practice Location

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