Provider Demographics
NPI:1548815764
Name:FAIX, CRYSTAL LEE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE
Last Name:FAIX
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 1:10929 NW 35TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4972
Mailing Address - Country:US
Mailing Address - Phone:904-563-5519
Mailing Address - Fax:
Practice Address - Street 1:10929 NW 35TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4972
Practice Address - Country:US
Practice Address - Phone:904-563-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9407657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse