Provider Demographics
NPI:1407884174
Name:NIEVES-CRUZ, NANCY (MD)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:NIEVES-CRUZ
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 1:1417 LAKELAND HILLS BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3208
Mailing Address - Country:US
Mailing Address - Phone:863-688-5811
Mailing Address - Fax:863-688-5866
Practice Address - Street 1:1417 LAKELAND HILLS BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3208
Practice Address - Country:US
Practice Address - Phone:863-688-5811
Practice Address - Fax:863-688-5866
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-20572Medicare UPIN
PR28760Medicare ID - Type Unspecified