Provider Demographics
NPI:1851880819
Name:PHILLIPS CRUZ, SHANDA (APRN)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:
Last Name:PHILLIPS 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 1:3017 W CHARLESTON BLVD STE 60
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1927
Mailing Address - Country:US
Mailing Address - Phone:702-778-5100
Mailing Address - Fax:702-778-5101
Practice Address - Street 1:3017 W CHARLESTON BLVD STE 60
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1927
Practice Address - Country:US
Practice Address - Phone:702-778-5100
Practice Address - Fax:702-778-5101
Is Sole Proprietor?:No
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily