Provider Demographics
NPI:1801637905
Name:CROSS, TAVIS ANTHONY (APRN)
Entity type:Individual
Prefix:MR
First Name:TAVIS
Middle Name:ANTHONY
Last Name:CROSS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CONCH KEY WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5217
Mailing Address - Country:US
Mailing Address - Phone:786-223-2348
Mailing Address - Fax:
Practice Address - Street 1:300 CONCH KEY WAY
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5217
Practice Address - Country:US
Practice Address - Phone:786-223-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily