Individual
CHRYSTAL A WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP
Contact information
Practice address
250 S WICKHAM RD, MELBOURNE, FL 32904-1134
(321) 752-5210
Mailing address
250 S WICKHAM RD, MELBOURNE, FL 32904-1134
(321) 752-5210
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN11013902
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111741300
—
FL
01
—
S8613
MEDICARE HF
FL
Enumeration date
06/25/2021
Last updated
07/01/2024
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