Provider Demographics
NPI:1932770104
Name:CRUZ, ELVIS KENDRICK (FNP)
Entity Type:Individual
Prefix:MR
First Name:ELVIS
Middle Name:KENDRICK
Last Name:CRUZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 BURNS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4304
Mailing Address - Country:US
Mailing Address - Phone:561-626-1092
Mailing Address - Fax:
Practice Address - Street 1:3345 BURNS RD
Practice Address - Street 2:STE 105, 206, 306
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-626-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347609363LF0000X
FL11014428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily