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Individual

MS. CRYSTAL DEJESUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
19735 US HIGHWAY 441 FL 1, MOUNT DORA, FL 32757-2204
(352) 735-5700
(352) 735-5701
Mailing address
7620 LAKE UNDERHILL RD, ORLANDO, FL 32822-8223
(321) 235-0692
(321) 235-0694

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9106616
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA9106616
LICENSE
FL
Enumeration date
06/19/2012
Last updated
09/25/2023
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