MEDICARE: DEANA CRUZ

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1386309680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANA CRUZ

Provider Business Mailing Address
First Line	:	1061 HARMON AVE
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31314-5641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8830 WATKINS AVE
Second Line	:
City	:	FORT MOORE
State	:	GA
Zip	:	31905-5529
Country	:	US
Telephone Number	:	706-544-0188
Fax Number	:

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

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	06/07/2024

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Directions to “ DEANA CRUZ ” Practice Location

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