Provider Demographics
NPI:1912486473
Name:CRUZ, JOELYN DANEIL ADA
Entity Type:Individual
Prefix:
First Name:JOELYN
Middle Name:DANEIL ADA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28466 E 6TH PL
Mailing Address - Street 2:
Mailing Address - City:WATKINS
Mailing Address - State:CO
Mailing Address - Zip Code:80137-8958
Mailing Address - Country:US
Mailing Address - Phone:706-761-8808
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-430-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN0103371-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health