Provider Demographics
NPI:1124729447
Name:CREEDON, SASHA JULIA (FNP)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:JULIA
Last Name:CREEDON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:JULIA
Other - Last Name:MANDLE GUEVARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 AVENUE B APT 1341
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2304
Mailing Address - Country:US
Mailing Address - Phone:507-261-8389
Mailing Address - Fax:
Practice Address - Street 1:22211 I-10 WEST
Practice Address - Street 2:SUITE 1206
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257
Practice Address - Country:US
Practice Address - Phone:210-972-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily