Provider Demographics
NPI:1235397910
Name:CRUZ, JENNIFER (AP DAOM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:AP DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 82ND AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1835
Mailing Address - Country:US
Mailing Address - Phone:786-236-6947
Mailing Address - Fax:
Practice Address - Street 1:13224 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-2228
Practice Address - Country:US
Practice Address - Phone:954-400-5504
Practice Address - Fax:954-400-5503
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51421225700000X
FLAP 3349171100000X
FL225700000171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP3349OtherLICENSED ACUPUNCTURIST
FL7635503OtherCAQH
FLMA51421OtherLICENSED MASSAGE THERAPIST