MEDICARE: DR. JOSE MANUEL CRUZ CRNA

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	367500000X	Certified Registered Nurse Anesthetist	0024195564	VA
2	367500000X	Certified Registered Nurse Anesthetist	154777	FL
3	163W00000X	Registered Nurse	9469146	FL
4	367500000X	Certified Registered Nurse Anesthetist	APRN11039891	FL

General Provider Information

NPI Number	:	1629861869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE MANUEL CRUZ CRNA

Provider Business Mailing Address
First Line	:	1225 PARK LAKE ST APT 1
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4159
Country	:	US
Telephone Number	:	347-382-0198
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 PARK LAKE ST APT 1
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4159
Country	:	US
Telephone Number	:	347-382-0198
Fax Number	:

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

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	02/04/2026

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