Provider Demographics
NPI:1740364033
Name:CRUZ, MICHAEL R (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:CRUZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 UPTAIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5671
Mailing Address - Country:US
Mailing Address - Phone:423-855-0700
Mailing Address - Fax:
Practice Address - Street 1:1559 SPARTA RD
Practice Address - Street 2:RIVER PARK HOSPITAL
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:423-855-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN8915367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0185251OtherBLUE CROSS BLUE SHIELD
TN3600767Medicaid
TN430039253OtherRR MEDICARE
TN430039253OtherRR MEDICARE