Provider Demographics
NPI:1487247805
Name:DE LEON, CRESPA CRISTE (CPN, MSN-FNP-C)
Entity type:Individual
Prefix:
First Name:CRESPA
Middle Name:CRISTE
Last Name:DE LEON
Suffix:
Gender:F
Credentials:CPN, MSN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8872 BERGAMO CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3050
Mailing Address - Country:US
Mailing Address - Phone:209-327-8731
Mailing Address - Fax:
Practice Address - Street 1:1805 N CALIFORNIA ST STE 409
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6033
Practice Address - Country:US
Practice Address - Phone:209-476-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty