Basic Information
| Provider Information | |||||||||
| NPI: | 1760864854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUMLEY | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5178 REYNOLDS RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384019522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316268262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1545 AIRPORT BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504166933 | ||||||||
| FaxNumber: | 8504166934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2015 | ||||||||
| LastUpdateDate: | 12/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9408673 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.