Healthcare Provider Details

I. General information

NPI: 1366308272
Provider Name (Legal Business Name): LEYISET CRESPO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14811 NW 89TH AVE
MIAMI LAKES FL
33018-8012
US

IV. Provider business mailing address

14811 NW 89TH AVE
MIAMI LAKES FL
33018-8012
US

V. Phone/Fax

Practice location:
  • Phone: 954-665-0071
  • Fax:
Mailing address:
  • Phone: 954-665-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17846I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11043389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: