Provider Demographics
NPI:1760021968
Name:LEON, KRYSTAL (APRN)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 SW 104TH ST # 17661
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2631
Mailing Address - Country:US
Mailing Address - Phone:305-702-2132
Mailing Address - Fax:
Practice Address - Street 1:7800 SW 104TH ST # 17661
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2631
Practice Address - Country:US
Practice Address - Phone:305-702-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily