Provider Demographics
NPI:1790386548
Name:NIEVES, CRUZ MIGDALIA
Entity Type:Individual
Prefix:
First Name:CRUZ
Middle Name:MIGDALIA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6544 CALUSA DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3767
Mailing Address - Country:US
Mailing Address - Phone:863-327-3586
Mailing Address - Fax:
Practice Address - Street 1:6745 N CHURCH AVE
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-2080
Practice Address - Country:US
Practice Address - Phone:863-701-8049
Practice Address - Fax:863-701-8632
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist