Provider Demographics
NPI:1508453309
Name:CRUZ MARTINEZ, OCTAVIO DE JESUS (FNP)
Entity Type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:DE JESUS
Last Name:CRUZ MARTINEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2857 GRAND BEND CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9185
Mailing Address - Country:US
Mailing Address - Phone:786-975-5433
Mailing Address - Fax:
Practice Address - Street 1:2857 GRAND BEND CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9185
Practice Address - Country:US
Practice Address - Phone:786-975-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner