Provider Demographics
NPI:1689638264
Name:CRUZ, MARCY L (RNFA)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:L
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:
Other - Last Name:CONNER CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNFA
Mailing Address - Street 1:5155 E. EAGLE DRIVE #20730
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-3031
Mailing Address - Country:US
Mailing Address - Phone:480-706-9430
Mailing Address - Fax:480-378-2273
Practice Address - Street 1:5155 E. EAGLE DRIVE #20733
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85277-3031
Practice Address - Country:US
Practice Address - Phone:480-706-9430
Practice Address - Fax:480-378-2273
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN071749363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAW2076OtherHEALTHNET OF AZ
AZAZ0280730OtherBCBS AZ
AZ878845Medicaid