MEDICARE: JANET ALECIA CRUZADO CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	1-147061	AL

General Provider Information

NPI Number	:	1124505326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET ALECIA CRUZADO CRNP

Provider Business Mailing Address
First Line	:	70 PLAZA DR
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-9314
Country	:	US
Telephone Number	:	205-814-9284
Fax Number	:	205-814-9626

Provider Business Practice Location Address
First Line	:	2834 MOODY PKWY
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3101
Country	:	US
Telephone Number	:	205-640-2808
Fax Number	:	205-640-2810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2018
Last Update Date	:	07/20/2018

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