Healthcare Provider Details

I. General information

NPI: 1457971186
Provider Name (Legal Business Name): KAREN CRUZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

883 SAMPLES LN NW
ATLANTA GA
30318-4951
US

V. Phone/Fax

Practice location:
  • Phone: 404-457-8306
  • Fax:
Mailing address:
  • Phone: 404-457-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN255693
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN255693
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRN255693
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: