Provider Demographics
NPI:1235835513
Name:CRESPO CUELLAR, LIS BETTY (APRN)
Entity Type:Individual
Prefix:
First Name:LIS
Middle Name:BETTY
Last Name:CRESPO CUELLAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-939-9876
Practice Address - Street 1:12995 S CLEVELAND AVE STE 184
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7703
Practice Address - Country:US
Practice Address - Phone:239-226-2727
Practice Address - Fax:239-939-9876
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily