Provider Demographics
NPI:1588674816
Name:CRUISE, CINDY C (NP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:C
Last Name:CRUISE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:C
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1850 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3404
Mailing Address - Country:US
Mailing Address - Phone:601-376-2471
Mailing Address - Fax:601-376-2570
Practice Address - Street 1:1850 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3404
Practice Address - Country:US
Practice Address - Phone:601-376-2471
Practice Address - Fax:601-376-2570
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR530409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR82993Medicare UPIN