Provider Demographics
NPI:1184261125
Name:CRUCE, DEENA
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:CRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEENA
Other - Middle Name:MARIE
Other - Last Name:RUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DEENA RUTH
Mailing Address - Street 1:4800 NW 19TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3434
Mailing Address - Country:US
Mailing Address - Phone:352-226-4400
Mailing Address - Fax:
Practice Address - Street 1:4800 NW 19TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3434
Practice Address - Country:US
Practice Address - Phone:352-226-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100079811251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare