Provider Demographics
NPI:1497421630
Name:CRUZ, MELISSA ROSARIO (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ROSARIO
Last Name:CRUZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 71ST AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-4424
Mailing Address - Country:US
Mailing Address - Phone:786-546-4440
Mailing Address - Fax:
Practice Address - Street 1:4715 71ST AVE N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4424
Practice Address - Country:US
Practice Address - Phone:786-546-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOH268OtherMEDICARE HF
FL112176200Medicaid