Provider Demographics
NPI:1275011884
Name:DAITZ, KRYSTAL RENAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:RENAE
Last Name:DAITZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2469 BAY AREA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1519
Mailing Address - Country:US
Mailing Address - Phone:281-486-0613
Mailing Address - Fax:
Practice Address - Street 1:2469 BAY AREA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1519
Practice Address - Country:US
Practice Address - Phone:281-474-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP137411OtherN/A