Provider Demographics
NPI:1649741000
Name:CRESPO, PATRICIA EILEEN (NURSE PRATITIONER)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EILEEN
Last Name:CRESPO
Suffix:
Gender:F
Credentials:NURSE PRATITIONER
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:EILEEN
Other - Last Name:REZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1317 CALLE DEL ORO
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7543
Mailing Address - Country:US
Mailing Address - Phone:915-249-6257
Mailing Address - Fax:
Practice Address - Street 1:1317 CALLE DEL ORO
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7543
Practice Address - Country:US
Practice Address - Phone:915-249-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily