Provider Demographics
NPI:1417843582
Name:SMITH, MICHAELA CRUZ (NP)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:CRUZ
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1894
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:NM
Mailing Address - Zip Code:87416-1894
Mailing Address - Country:US
Mailing Address - Phone:702-978-2125
Mailing Address - Fax:
Practice Address - Street 1:656 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5968
Practice Address - Country:US
Practice Address - Phone:505-609-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM82673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily