Healthcare Provider Details

I. General information

NPI: 1184143125
Provider Name (Legal Business Name): JOSHUA JAMES CRUZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-8566
  • Fax: 402-481-8805
Mailing address:
  • Phone: 402-481-8566
  • Fax: 402-481-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005141
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2181
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0005141
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number110766
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: