Provider Demographics
NPI:1558569426
Name:D'CRUZ, JOAN COLETTE (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:COLETTE
Last Name:D'CRUZ
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 BRIDGEWATER LN STE 103
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4103
Mailing Address - Country:US
Mailing Address - Phone:423-245-2406
Mailing Address - Fax:423-245-2404
Practice Address - Street 1:1536 BRIDGEWATER LN STE 103
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4103
Practice Address - Country:US
Practice Address - Phone:423-245-2406
Practice Address - Fax:423-245-2404
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health