Provider Demographics
NPI:1053463075
Name:CRUIKSHANK, BARBARA LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LEIGH
Last Name:CRUIKSHANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5571
Practice Address - Country:US
Practice Address - Phone:904-269-2900
Practice Address - Fax:904-269-1140
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05937OtherBCBS
FL320007628OtherHUMANA
FL4618068OtherAETNA
FL05937OtherBCBS
FL4618068OtherAETNA