Individual
CRYSTAL WEAKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8010 SUMMERLIN LAKES DR, SUITE 100, FORT MYERS, FL 33907-1849
(239) 939-1767
(239) 939-5895
Mailing address
8010 SUMMERLIN LAKES DR, SUITE 100, FORT MYERS, FL 33907-1849
(239) 939-1767
(239) 939-5895
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9100925
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290598100
—
FL
01
—
P00145895
RAILROAD MEDICARE
—
Enumeration date
06/26/2006
Last updated
07/08/2007
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