Provider Demographics
NPI:1639730658
Name:SOSA CRUZ, LIDIANA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LIDIANA
Middle Name:
Last Name:SOSA 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 1:9432 SW 155TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1114
Mailing Address - Country:US
Mailing Address - Phone:305-801-4778
Mailing Address - Fax:
Practice Address - Street 1:9432 SW 155TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1114
Practice Address - Country:US
Practice Address - Phone:305-801-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily