MEDICARE: MRS. EILEEN RUIZ-CRUZ ARNP

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	363LA2200X	Adult Health Nurse Practitioner	ARNP 9253525	FL
2	363LG0600X	Gerontology Nurse Practitioner	ARNP 9253525	FL
3	363LP2300X	Primary Care Nurse Practitioner	ARNP 9253525	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164849618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EILEEN RUIZ-CRUZ ARNP

Provider Business Mailing Address
First Line	:	14016 LAKE LURE CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-3051
Country	:	US
Telephone Number	:	786-693-0508
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 W 16TH AVE
Second Line	:	#56
City	:	HIALEAH
State	:	FL
Zip	:	33012-7100
Country	:	US
Telephone Number	:	305-824-8559
Fax Number	:

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

Provider Enumeration Date	:	03/22/2014
Last Update Date	:	03/22/2014

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