Provider Demographics
NPI:1285228940
Name:CRUZ, ELISABETH EVE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:EVE
Last Name:CRUZ
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Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:130 PROVIDENCE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1247
Mailing Address - Country:US
Mailing Address - Phone:704-333-9113
Mailing Address - Fax:704-333-9757
Practice Address - Street 1:130 PROVIDENCE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1247
Practice Address - Country:US
Practice Address - Phone:704-333-9113
Practice Address - Fax:704-333-9757
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2022-07-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant