Healthcare Provider Details

I. General information

NPI: 1942122064
Provider Name (Legal Business Name): JAQUISHA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 BLUE STREAM WAY APT 5101
INLET BEACH FL
32461-8621
US

IV. Provider business mailing address

231 BLUE STREAM WAY APT 5101
INLET BEACH FL
32461-8621
US

V. Phone/Fax

Practice location:
  • Phone: 850-896-3873
  • Fax:
Mailing address:
  • Phone: 850-896-3873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: