Healthcare Provider Details

I. General information

NPI: 1316744790
Provider Name (Legal Business Name): JOSE CARLOS CRUZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 10/26/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 CENTURY FARMS PKWY
ANTIOCH TN
37013-4197
US

IV. Provider business mailing address

2127 CENTURY FARMS PKWY
ANTIOCH TN
37013-4197
US

V. Phone/Fax

Practice location:
  • Phone: 615-781-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number40100
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number220263
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: