Gordon, Krystal

Gordon, Krystal is an individual health care provider with primary practice located at 260 Beth Stacey Blvd # C , Lehigh Acres FL 33936-6074. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Critical Care, which is considered as her primary health care specialty. Gordon, Krystal can be contacted via phone (239) 343-9888.

Contact Information

Primary practice address
260 Beth Stacey Blvd # C Lehigh Acres FL 33936-6074
Phone: (239) 343-9888
Fax: (239) 303-0714
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Critical Care 363LP0222X APRN11002846 Florida

Profile Details

NPI number 1568022523
LBN Legal business name Gordon, Krystal
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2019
Last updated Aug 10th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568022523 NPPES
Florida MEDICAID 103687500

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