Provider Demographics
NPI:1710387204
Name:CRUZ, DO (ANP, WHNP)
Entity Type:Individual
Prefix:
First Name:DO
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:ANP, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 GWINNETT PLACE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4708
Mailing Address - Country:US
Mailing Address - Phone:770-864-5510
Mailing Address - Fax:
Practice Address - Street 1:3525 GWINNETT PLACE DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4708
Practice Address - Country:US
Practice Address - Phone:770-864-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226144363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health