Provider Demographics
NPI:1457863334
Name:CRESAP, DAVID ALONZO (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALONZO
Last Name:CRESAP
Suffix:
Gender:M
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 1:2216 N ALMOND
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2232
Mailing Address - Country:US
Mailing Address - Phone:602-315-9053
Mailing Address - Fax:
Practice Address - Street 1:2216 N ALMOND
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-2232
Practice Address - Country:US
Practice Address - Phone:602-315-9053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily