Provider Demographics
NPI:1245938794
Name:CRUZ SANTOVENIA, JESUS M (APRN)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:CRUZ SANTOVENIA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 NW 33RD AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2814
Mailing Address - Country:US
Mailing Address - Phone:786-344-5733
Mailing Address - Fax:
Practice Address - Street 1:9150 NW 33RD AVENUE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2814
Practice Address - Country:US
Practice Address - Phone:786-344-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily