Provider Demographics
NPI:1053030882
Name:CRESPO, ANGEL (APRN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:CRESPO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S CORONA ST # 612
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-4404
Mailing Address - Country:US
Mailing Address - Phone:863-677-7571
Mailing Address - Fax:
Practice Address - Street 1:612 S CORONA ST # 612
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-4404
Practice Address - Country:US
Practice Address - Phone:863-677-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily