Provider Demographics
NPI:1154962272
Name:MORRIS, CHRYSTLE GAYE
Entity type:Individual
Prefix:
First Name:CHRYSTLE
Middle Name:GAYE
Last Name:MORRIS
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 1:7051 ENVIRON BLVD APT 432
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4210
Mailing Address - Country:US
Mailing Address - Phone:954-256-4464
Mailing Address - Fax:
Practice Address - Street 1:851 TRAFALGAR CT STE 200E
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7420
Practice Address - Country:US
Practice Address - Phone:321-422-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005965367500000X
FLRN9363951163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine