Provider Demographics
NPI:1144934357
Name:CRAWFORD, KRISTI EVE
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:EVE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 MACK BAYOU LOOP STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7210
Mailing Address - Country:US
Mailing Address - Phone:850-278-3920
Mailing Address - Fax:850-278-3919
Practice Address - Street 1:179 MACK BAYOU LOOP STE 201
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7210
Practice Address - Country:US
Practice Address - Phone:850-233-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily