Provider Demographics
NPI:1528825395
Name:CRANDELL, ABBIN ETHAN (RN, CDCES)
Entity type:Individual
Prefix:MR
First Name:ABBIN
Middle Name:ETHAN
Last Name:CRANDELL
Suffix:
Gender:M
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 RIVERDALE LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-3414
Mailing Address - Country:US
Mailing Address - Phone:904-329-5140
Mailing Address - Fax:
Practice Address - Street 1:19 RIVERDALE LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-3414
Practice Address - Country:US
Practice Address - Phone:904-329-5140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9356329163W00000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse