Provider Demographics
NPI:1942605936
Name:DE LA CRUZ, MARIA ROSARIO AGUSTIN (MSN, CRNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIA ROSARIO
Middle Name:AGUSTIN
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-C
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Mailing Address - Street 1:6279 BAYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20637-2575
Mailing Address - Country:US
Mailing Address - Phone:301-814-8228
Mailing Address - Fax:240-254-2187
Practice Address - Street 1:15485 PRINCE FREDERICK RD # 102
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20637-9998
Practice Address - Country:US
Practice Address - Phone:301-814-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR163177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily