Provider Demographics
NPI:1588114748
Name:AGUIRRE, KRYSTAL LEE (FNP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LEE
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:SANDQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13801 HOPI RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5714
Mailing Address - Country:US
Mailing Address - Phone:760-221-9266
Mailing Address - Fax:
Practice Address - Street 1:18064 WIKA RD
Practice Address - Street 2:SUITE NUMBER 103
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2125
Practice Address - Country:US
Practice Address - Phone:760-240-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily