Provider Demographics
NPI:1033795760
Name:DE LA CRUZ, VIMARI (ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:VIMARI
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SILVER PALM AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3123
Mailing Address - Country:US
Mailing Address - Phone:321-241-6800
Mailing Address - Fax:
Practice Address - Street 1:17 SILVER PALM AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3123
Practice Address - Country:US
Practice Address - Phone:321-241-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily