Provider Demographics
NPI:1407271463
Name:DEA, CRYSTAL JADE (FNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JADE
Last Name:DEA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 OYSTER POINT BLVD STE 512
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1973
Mailing Address - Country:US
Mailing Address - Phone:650-826-2945
Mailing Address - Fax:
Practice Address - Street 1:1390 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5404
Practice Address - Country:US
Practice Address - Phone:877-619-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23203363LF0000X
NVTAPRN700988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily