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Search › Florida › 363LA2200X

Crystal Wade, MSN, AG-ACNP-BC

NPI 1073173142 · on the registry since 2019

Practice

Address
12574 Flagler Center Blvd Ste 101
Jacksonville, FL 32258
Phone
(904) 674-8037
Fax
(904) 582-1608
Organisation at this address
Origin Diagnostics
Hypermobility Hub Llc
First Coast Medicine Pllc
Dr. Elisa Laconich, Ph.D., Pllc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
4

Registry record

Primary taxonomy
363LA2200X
363LA2200X
Also registered as
363L00000X
363LF0000X
Licence states on file
FL
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2026-08-28

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida