Healthcare Provider Details

I. General information

NPI: 1356934699
Provider Name (Legal Business Name): IDELYS VALDES CRESPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S HIGHLAND AVE
CLEARWATER FL
33756-4446
US

IV. Provider business mailing address

855 S HIGHLAND AVE
CLEARWATER FL
33756-4446
US

V. Phone/Fax

Practice location:
  • Phone: 727-219-1833
  • Fax: 727-330-2908
Mailing address:
  • Phone: 727-219-1833
  • Fax: 727-330-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: