Provider Demographics
NPI:1295508026
Name:DE LA CRUZ, RUBY
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:
Other - Last Name:DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C,CRNP
Mailing Address - Street 1:4478 COLE FARM RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2976
Mailing Address - Country:US
Mailing Address - Phone:443-928-6438
Mailing Address - Fax:
Practice Address - Street 1:4478 COLE FARM RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2976
Practice Address - Country:US
Practice Address - Phone:443-928-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily