Provider Demographics
NPI:1861385544
Name:CASTOR, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CASTOR
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:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:FL
Mailing Address - Zip Code:32187-0281
Mailing Address - Country:US
Mailing Address - Phone:386-213-0431
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 281
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:FL
Practice Address - Zip Code:32187-0281
Practice Address - Country:US
Practice Address - Phone:386-213-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL401392376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide