Provider Demographics
NPI:1972802510
Name:CRUZ, FAITH MOORE (ARNP)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:MOORE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1541 MEDICAL DRIVE
Mailing Address - Street 2:URGENT CARE CENTER
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-431-7801
Mailing Address - Fax:850-431-7809
Practice Address - Street 1:1541 MEDICAL DRIVE
Practice Address - Street 2:URGENT CARE CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-431-7801
Practice Address - Fax:850-431-7809
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9265787363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
EX463YMedicare PIN