Provider Demographics
NPI:1619552163
Name:BOYCE, CRYSTAL M (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:BOYCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:BASTEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:282 WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-305-6541
Mailing Address - Fax:860-837-6387
Practice Address - Street 1:282 WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-305-6541
Practice Address - Fax:860-837-5540
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9357363LP0200X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics