Healthcare Provider Details

I. General information

NPI: 1164849618
Provider Name (Legal Business Name): EILEEN RUIZ-CRUZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2014
Last Update Date: 03/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE #56
HIALEAH FL
33012-7100
US

IV. Provider business mailing address

14016 LAKE LURE CT
MIAMI LAKES FL
33014-3051
US

V. Phone/Fax

Practice location:
  • Phone: 305-824-8559
  • Fax:
Mailing address:
  • Phone: 786-693-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 9253525
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP 9253525
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP 9253525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: