MEDICARE: JESSICA A CRUZ APN, RN

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	363LF0000X	Family Nurse Practitioner	APN001220	NV

General Provider Information

NPI Number	:	1427364868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA A CRUZ APN, RN

Provider Business Mailing Address
First Line	:	5876 S PECOS RD
Second Line	:	BLDG. B
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3418
Country	:	US
Telephone Number	:	702-733-0744
Fax Number	:	702-796-8262

Provider Business Practice Location Address
First Line	:	5876 S PECOS RD
Second Line	:	BLDG. B
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3418
Country	:	US
Telephone Number	:	702-733-0744
Fax Number	:	702-796-8262

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

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	04/14/2014

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