Healthcare Provider Details

I. General information

NPI: 1376938183
Provider Name (Legal Business Name): JASMINE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 GRIFFIN RD
FT LAUDERDALE FL
33312-5856
US

IV. Provider business mailing address

9835 LAKE WORTH RD STE 16-152
LAKE WORTH FL
33467-2300
US

V. Phone/Fax

Practice location:
  • Phone: 954-853-2160
  • Fax: 561-258-9674
Mailing address:
  • Phone: 877-827-8946
  • Fax: 561-258-9674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO3913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: