Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | ARNP9362887 | FL |
N | 363LG0600X | Nurse Practitioner - Gerontology | ARNP9362887 | FL |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | ARNP9362887 | FL |
N | 363LP2300X | Nurse Practitioner - Primary Care | ARNP9362887 | FL |
NPI | 1003269424 |
---|---|
Provider Name | Crystal Elaine Blair |
First Address | Tampa, FL 33612-4745 |
Second Address | Tampa, FL 33612-4745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2016 |
Last Update Date | 19/01/2017 |