Individual
KRYSTAL M BUCKLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1150 N 35TH AVE, STE 345, HOLLYWOOD, FL 33021
(954) 986-6300
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA 9103945
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2928337-00
—
FL
01
—
AA241V
MEDICARE PTAN
FL
Enumeration date
10/31/2006
Last updated
12/26/2017
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