Provider Demographics
NPI:1396791950
Name:CRUZ, ERWIN OSIRIS (FNP-C)
Entity type:Individual
Prefix:MR
First Name:ERWIN
Middle Name:OSIRIS
Last Name:CRUZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 PONCE DE LEON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1806
Mailing Address - Country:US
Mailing Address - Phone:404-343-2672
Mailing Address - Fax:404-343-6195
Practice Address - Street 1:552 PONCE DE LEON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1806
Practice Address - Country:US
Practice Address - Phone:404-343-2672
Practice Address - Fax:404-343-6195
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085019NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBLBHMedicare UPIN
GAS65103Medicare UPIN