Provider Demographics
NPI:1700518552
Name:DE LA CRUZ, VIOLET HOLLY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:HOLLY
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:VIOLET
Other - Middle Name:HOLLY
Other - Last Name:DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1701 LACEY ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5230
Mailing Address - Country:US
Mailing Address - Phone:573-334-4822
Mailing Address - Fax:
Practice Address - Street 1:1723 BROADWAY ST STE 315
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4556
Practice Address - Country:US
Practice Address - Phone:573-519-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022028299363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care