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General NPI Number Information
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NPI Number | 1417056409
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Entity Type | Individual
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Provider Name | SAMYA VARUSCHKA CRUZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 7665 W HWY 70 SUITE 101
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City | BARTLETT
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State | TN
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Zip | 38133
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Country | US
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Telephone | 901-207-6535
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Fax | 901-417-7894
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Provider Business Mailing Address
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Address Line | 777 W POPLAR AVE STE 104
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City | COLLIERVILLE
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State | TN
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Zip | 38017-6500
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Country | US
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Telephone | 901-221-7175
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Fax | 901-221-7193
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 59106
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01062943A
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License Number State | IN
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