Provider Demographics
NPI:1063053247
Name:TAYLOR, CRISTINA LEONARDO (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:CRISTINA
Middle Name:LEONARDO
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:LEONARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10325 LAKE JUNE RD STE 330
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-5328
Mailing Address - Country:US
Mailing Address - Phone:214-928-9800
Mailing Address - Fax:
Practice Address - Street 1:1350 S MAIN ST STE 3200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7669
Practice Address - Country:US
Practice Address - Phone:817-702-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372688701Medicaid