Crystal A Ciszek, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11020853 Issued in FL

Practice address

10752 Deerwood Park Blvd Ste 100
Jacksonville, FL 32256-4846

Phone

(478) 290-0677

NPI assigned

Feb 8, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Crystal A Ciszek Former name

Medicare fee-for-service enrollment

Enrolled in GA, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

At Home Palliative Care, LLCGroup PAC ID 3274900410, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: crystal.morgan@dimphy.gadirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• At Home Palliative Care, LLC

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Jacksonville, FL
  • NPI 1790406148

  FL, GA

  Medicare reassignment Care Compare group NPD Authorized official
• The Clinicians, LLC

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1346669447

  FL

  Medicare reassignment NPD
• Travel Doctor, PL

  • Urgent Care Clinic/Center
  • Tampa, FL
  • NPI 1164842225

  FL

  Medicare reassignment NPD
• Langford Allergy LLC

  • Allergy & Immunology Physician
  • Macon, GA
  • NPI 1215351291

  GA

  Medicare reassignment NPD
• Ahpc Health Incorporated

  • Primary Care Nurse Practitioner
  • Jacksonville, FL
  • NPI 1952279101
  NPD Authorized official
• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  FL

  Medicare reassignment
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  GA

  Medicare reassignment
• Dublin Internal Medicine

  • Internal Medicine Physician
  • Dublin, GA
  • NPI 1073618856
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662336000000",
    "number": "1124486089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "463688 STATE ROAD 200, STE 1",
            "address_2": "#364",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "320970304",
            "telephone_number": "478-290-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10752 DEERWOOD PARK BLVD STE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322564846",
            "telephone_number": "478-290-0677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 Fairview Park Dr",
            "address_purpose": "LOCATION",
            "city": "Dublin",
            "state": "GA",
            "postal_code": "310212500",
            "country_code": "US",
            "telephone_number": "478-272-1366",
            "fax_number": "478-277-1251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1831 E 71st St",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741363922",
            "country_code": "US",
            "telephone_number": "866-949-0108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "774 Highway 96",
            "address_purpose": "LOCATION",
            "city": "Bonaire",
            "state": "GA",
            "postal_code": "310053300",
            "country_code": "US",
            "telephone_number": "478-988-5711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CISZEK",
        "first_name": "CRYSTAL",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-08",
        "last_updated": "2022-09-05",
        "certification_date": "2022-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN209456",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11020853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "CISZEK",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Janae V Cisero, PT
• Nicole Cisler
• Manuela Claudia Cismaru, ARNP
• Mario Cisneros
• Carly Elise Cisson, LMHC, NCC
• Lacresa Larae Citizen, RN
• City Hope Homemaker and Companion Care LLC
• City of Jacksonville
• City Transportation of Jax,LLC
• CJ New Path

• All providers in Jacksonville, FL
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.