Healthcare Provider Details

I. General information

NPI: 1356761324
Provider Name (Legal Business Name): DEBORAH ANNE CRUZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST 1252 THOMPSON BUILDING
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

111 STREET. 11TH STREET. 1252 THOMPSON BUILDING JEFFERSON UNIVERSITY HOSPITAL
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7833
  • Fax: 215-923-3608
Mailing address:
  • Phone: 215-955-7833
  • Fax: 215-923-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License NumberVP003519T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: