Basic Information
| Provider Information | |||||||||
| NPI: | 1891340568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELASCO | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | PASCUA | ||||||||
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| Credential: | MSN, AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4749 CHAUCER CT | ||||||||
| Address2: | |||||||||
| City: | GRAND PRAIRIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750528375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146827027 | ||||||||
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| Practice Location | |||||||||
| Address1: | 221 W COLORADO BLVD STE 525 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752082312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149605681 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2019 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | AP142479 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.