Provider Demographics
NPI:1619561834
Name:MASCOLA, KRYSTOL RAYE (CNP WHNP)
Entity Type:Individual
Prefix:
First Name:KRYSTOL
Middle Name:RAYE
Last Name:MASCOLA
Suffix:
Gender:F
Credentials:CNP WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W 34TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1916
Mailing Address - Country:US
Mailing Address - Phone:737-279-5781
Mailing Address - Fax:737-279-5953
Practice Address - Street 1:1111 W 34TH ST STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1916
Practice Address - Country:US
Practice Address - Phone:737-279-5781
Practice Address - Fax:737-279-5953
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024386363L00000X
TX1074351363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health