Provider Demographics
NPI:1225725898
Name:CRUZ, SHAWNETTE (FNP)
Entity Type:Individual
Prefix:
First Name:SHAWNETTE
Middle Name:
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 1:5938 JULIAN AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298
Mailing Address - Country:US
Mailing Address - Phone:908-347-0626
Mailing Address - Fax:
Practice Address - Street 1:1701 PINECROFT RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3876
Practice Address - Country:US
Practice Address - Phone:743-557-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320561163WE0003X
NC5018189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency