MEDICARE: DAMISELA FERNANDEZ CRUZ FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F02240598	FL

General Provider Information

NPI Number	:	1780449454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMISELA FERNANDEZ CRUZ FNP

Provider Business Mailing Address
First Line	:	5431 NW 186TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-5348
Country	:	US
Telephone Number	:	786-718-7874
Fax Number	:

Provider Business Practice Location Address
First Line	:	5431 NW 186TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-5348
Country	:	US
Telephone Number	:	786-718-7874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	02/24/2024

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