MEDICARE: DR. JACQUELINE STEPHANIE DE LA CRUZ MD

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	208D00000X	General Practice Physician	ACN1719	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	:	1467276295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE STEPHANIE DE LA CRUZ MD

Provider Business Mailing Address
First Line	:	PO BOX 4189
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-4189
Country	:	US
Telephone Number	:	954-363-9582
Fax Number	:	954-363-9663

Provider Business Practice Location Address
First Line	:	9109 S US HIGHWAY 1 STE 101
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-3453
Country	:	US
Telephone Number	:	772-398-1305
Fax Number	:	772-398-1307

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

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	06/19/2026

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