Individual
MRS. CRYSTAL ANN WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, AG-ACNP-BC
Contact information
Practice address
655 W. EIGHTH ST, ACC BUILDING 2ND FLOOR, JACKSONVILLE, FL 32209-3220
(904) 244-1010
Mailing address
2285 MARSH HAWK LN APT 13102, FLEMING ISLAND, FL 32003-3309
(757) 291-3876
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11002837
FL
363LA2200X
Adult Health Nurse Practitioner
Primary
11002837
FL
363LF0000X
Family Nurse Practitioner
11002837
FL
Other
Enumeration date
06/19/2019
Last updated
08/02/2022
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