Healthcare Provider Details

I. General information

NPI: 1033795760
Provider Name (Legal Business Name): VIMARI DE LA CRUZ ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 FLORIDA AVE NE APT 2
MELBOURNE FL
32905-2650
US

IV. Provider business mailing address

PO BOX 1137
MELBOURNE FL
32902-1137
US

V. Phone/Fax

Practice location:
  • Phone: 321-241-6800
  • Fax: 321-241-6890
Mailing address:
  • Phone: 321-241-6800
  • Fax: 321-241-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: