Provider Demographics
NPI:1457715831
Name:CRUZ KAUFFMAN, ROSA A (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:A
Last Name:CRUZ KAUFFMAN
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271369
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-1369
Mailing Address - Country:US
Mailing Address - Phone:970-235-0952
Mailing Address - Fax:
Practice Address - Street 1:1136 E STUART ST STE 4101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1173
Practice Address - Country:US
Practice Address - Phone:970-235-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994454-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health