Provider Demographics
NPI:1174384879
Name:HUNTER, CRYSTAL LYNN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:HUNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 EXCHANGE CT STE 185
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4000
Mailing Address - Country:US
Mailing Address - Phone:877-345-5300
Mailing Address - Fax:561-989-3665
Practice Address - Street 1:4700 EXCHANGE CT STE 185
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4000
Practice Address - Country:US
Practice Address - Phone:877-345-5300
Practice Address - Fax:561-989-3665
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant