Healthcare Provider Details

I. General information

NPI: 1780449454
Provider Name (Legal Business Name): DAMISELA FERNANDEZ CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 W 49TH ST STE 732-733
HIALEAH FL
33012-2942
US

IV. Provider business mailing address

1840 W 49TH ST STE 732-733
HIALEAH FL
33012-2942
US

V. Phone/Fax

Practice location:
  • Phone: 786-718-7874
  • Fax:
Mailing address:
  • Phone: 786-718-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02240598
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11033944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: