Provider Demographics
NPI:1366738015
Name:DE LA ROSA, KRYSTLE NICOLE (NP-C)
Entity type:Individual
Prefix:MISS
First Name:KRYSTLE
Middle Name:NICOLE
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-7000
Mailing Address - Fax:210-924-4113
Practice Address - Street 1:6315 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3218
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:210-924-4113
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX793780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily