Healthcare Provider Details

I. General information

NPI: 1417428095
Provider Name (Legal Business Name): MARIA E DE LA CRUZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PARK PLACE BLVD
KISSIMMEE FL
34741-2344
US

IV. Provider business mailing address

PO BOX 3340
WINDERMERE FL
34786-3321
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-0023
  • Fax: 407-483-0378
Mailing address:
  • Phone: 407-758-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11000482
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11000482
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11000482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: