Provider Demographics
NPI:1861488330
Name:CRUZ DIAZ, ANA C (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:C
Last Name:CRUZ DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5305
Mailing Address - Fax:352-616-0926
Practice Address - Street 1:7729 E PINE LAKE LN
Practice Address - Street 2:
Practice Address - City:FLORAL CITY
Practice Address - State:FL
Practice Address - Zip Code:34436-3745
Practice Address - Country:US
Practice Address - Phone:352-765-3003
Practice Address - Fax:352-616-0915
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN769208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016745300Medicaid
PR0023370Medicare PIN
PRI-37861Medicare UPIN