Provider Demographics
NPI:1225013832
Name:CRUZ, BLANCA E (FNP)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:E
Last Name:CRUZ
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 1:5501 S EXPRESSWAY 77
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3213
Mailing Address - Country:US
Mailing Address - Phone:956-365-1023
Mailing Address - Fax:956-365-1823
Practice Address - Street 1:5501 S EXPRESSWAY 77
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3213
Practice Address - Country:US
Practice Address - Phone:956-365-1023
Practice Address - Fax:956-365-1823
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285750003Medicaid
Q18998Medicare UPIN
TX285750003Medicaid