Provider Demographics
NPI:1588327753
Name:CRESPO DE QUESADA, JOHAN MANUEL (DNP,APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:JOHAN
Middle Name:MANUEL
Last Name:CRESPO DE QUESADA
Suffix:
Gender:M
Credentials:DNP,APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-3735
Mailing Address - Country:US
Mailing Address - Phone:713-923-2273
Mailing Address - Fax:713-923-2276
Practice Address - Street 1:3420 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-3735
Practice Address - Country:US
Practice Address - Phone:713-923-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily