Provider Demographics
NPI:1699588442
Name:TRINIDAD, CRYSTAL (FNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 W 67TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4103
Mailing Address - Country:US
Mailing Address - Phone:773-512-6193
Mailing Address - Fax:
Practice Address - Street 1:4415 HARRISON ST STE 247
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1919
Practice Address - Country:US
Practice Address - Phone:312-738-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily