Healthcare Provider Details

I. General information

NPI: 1447865639
Provider Name (Legal Business Name): MRS. YAIMARA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YAIMARA CRUZ YAIMARA, CRUZ

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 SW 79TH CT
PALMETTO BAY FL
33158-2019
US

IV. Provider business mailing address

14400 SW 79TH CT
PALMETTO BAY FL
33158-2019
US

V. Phone/Fax

Practice location:
  • Phone: 305-510-0111
  • Fax: 305-515-6870
Mailing address:
  • Phone: 305-510-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11015153
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11015153
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: