Provider Demographics
NPI:1760467641
Name:CRUZ, CHEUNITA R
Entity Type:Individual
Prefix:
First Name:CHEUNITA
Middle Name:R
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHEUNITA
Other - Middle Name:R
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP C
Mailing Address - Street 1:655 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098-2227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 PAGE RD
Practice Address - Street 2:OCCUPATIONAL MEDICINE SQUADRON
Practice Address - City:ROBINS AIR FORCE BASE
Practice Address - State:GA
Practice Address - Zip Code:30098-7627
Practice Address - Country:US
Practice Address - Phone:478-926-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR126162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA495467481AMedicaid
GA50BBHPSMedicare ID - Type Unspecified
GA495467481AMedicaid