Provider Demographics
NPI:1396343570
Name:DACASIN, KRISTA COURTNEY DIZON (MSN, APRN-CNP, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTA COURTNEY
Middle Name:DIZON
Last Name:DACASIN
Suffix:
Gender:F
Credentials:MSN, APRN-CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9890 CAPE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6329
Mailing Address - Country:US
Mailing Address - Phone:661-932-8129
Mailing Address - Fax:
Practice Address - Street 1:9890 CAPE VERDE DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6329
Practice Address - Country:US
Practice Address - Phone:661-742-8579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV832576363LF0000X
CA95025802363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily