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General NPI Number Information
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NPI Number | 1316744790
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Entity Type | Individual
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Provider Name | JOSE CARLOS CRUZ RN
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Gender | Male
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 10/26/2025
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Provider Practice Location Address
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Address Line | 2127 CENTURY FARMS PKWY
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City | ANTIOCH
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State | TN
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Zip | 37013-4197
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Country | US
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Telephone | 615-781-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2127 CENTURY FARMS PKWY
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City | ANTIOCH
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State | TN
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Zip | 37013-4197
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 40100
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 220263
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License Number State | TN
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