Basic Information
| Provider Information | |||||||||
| NPI: | 1972802510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | FAITH | ||||||||
| MiddleName: | MOORE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOORE | ||||||||
| OtherFirstName: | FAITH | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1541 MEDICAL DRIVE | ||||||||
| Address2: | URGENT CARE CENTER | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504317801 | ||||||||
| FaxNumber: | 8504317809 | ||||||||
| Practice Location | |||||||||
| Address1: | 1541 MEDICAL DRIVE | ||||||||
| Address2: | URGENT CARE CENTER | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504317801 | ||||||||
| FaxNumber: | 8504317809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2011 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9265787 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.