Provider Demographics
NPI:1487330429
Name:CRESPO VELAZCO, DAINERIS (ARNP)
Entity type:Individual
Prefix:
First Name:DAINERIS
Middle Name:
Last Name:CRESPO VELAZCO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SE 23RD AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1442
Mailing Address - Country:US
Mailing Address - Phone:786-346-8201
Mailing Address - Fax:
Practice Address - Street 1:3369 PINE RIDGE RD UNIT 203
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3932
Practice Address - Country:US
Practice Address - Phone:239-631-2662
Practice Address - Fax:239-631-8597
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9551981163W00000X
FL11025648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse