Healthcare Provider Details

I. General information

NPI: 1740776970
Provider Name (Legal Business Name): CHELSEA M. CRUZ DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST
PETERSON AFB CO
80914-1541
US

IV. Provider business mailing address

2706 94TH ST E
PALMETTO FL
34221-1705
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-2273
  • Fax:
Mailing address:
  • Phone: 941-301-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0000000000000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: