Provider Demographics
NPI:1669896080
Name:DELA CRUZ, LIA DONNA VELASQUEZ (FNP-BC)
Entity type:Individual
Prefix:
First Name:LIA DONNA
Middle Name:VELASQUEZ
Last Name:DELA CRUZ
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:FELIPA MARIE LIA DON
Other - Middle Name:VELASQUEZ
Other - Last Name:DELA CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:BOX 91 2978 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3820
Mailing Address - Country:US
Mailing Address - Phone:702-275-8947
Mailing Address - Fax:
Practice Address - Street 1:6070 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5615
Practice Address - Country:US
Practice Address - Phone:702-810-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY680264163W00000X
CA95034185363L00000X
NV887977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner