Provider Demographics
NPI:1699139881
Name:GARZA, CRYSTAL ANN (RN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:GARZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12551 LAKE CONROE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-5334
Mailing Address - Country:US
Mailing Address - Phone:936-443-2728
Mailing Address - Fax:
Practice Address - Street 1:12551 LAKE CONROE HILLS DR
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-5334
Practice Address - Country:US
Practice Address - Phone:936-443-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX880004163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse