Provider Demographics
NPI:1932585585
Name:CRUZ, AL JEROME CRISOLOGO (DNP, ARNP)
Entity Type:Individual
Prefix:
First Name:AL JEROME
Middle Name:CRISOLOGO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 S 56TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6900
Mailing Address - Country:US
Mailing Address - Phone:253-448-3271
Mailing Address - Fax:
Practice Address - Street 1:2115 S 56TH ST STE 304
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6900
Practice Address - Country:US
Practice Address - Phone:253-448-3271
Practice Address - Fax:253-218-6758
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022342163W00000X
WARN60587938163W00000X
WAAP60923894363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily