Provider Demographics
NPI:1629796115
Name:JOHNSTON GARCIA, CRYSTAL (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:JOHNSTON GARCIA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 PALASTRO WAY
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5012
Mailing Address - Country:US
Mailing Address - Phone:407-209-8832
Mailing Address - Fax:
Practice Address - Street 1:4106 W LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3315
Practice Address - Country:US
Practice Address - Phone:407-332-7700
Practice Address - Fax:407-332-9749
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021469363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily