Provider Demographics
NPI:1982255352
Name:GAZDA, CRYSTAL L (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:GAZDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:L
Other - Last Name:HUBBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:940 E 36TH ST N
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-1953
Mailing Address - Country:US
Mailing Address - Phone:918-398-9460
Mailing Address - Fax:918-992-2822
Practice Address - Street 1:940 E 36TH ST N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1953
Practice Address - Country:US
Practice Address - Phone:918-398-9460
Practice Address - Fax:918-992-2822
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK119492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily