Provider Demographics
NPI:1053032771
Name:CRESPO, CARMEN F
Entity type:Individual
Prefix:PROF
First Name:CARMEN
Middle Name:F
Last Name:CRESPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8731 MISSISSIPPI RUN
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-4048
Mailing Address - Country:US
Mailing Address - Phone:352-610-0038
Mailing Address - Fax:
Practice Address - Street 1:8731 MISSISSIPPI RUN
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-4048
Practice Address - Country:US
Practice Address - Phone:352-610-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider