Basic Information
| Provider Information | |||||||||
| NPI: | 1992304398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | JARED ROMER | ||||||||
| MiddleName: | BERNARDO | ||||||||
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| Credential: | FNP- BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 349 VERONICA CIR | ||||||||
| Address2: | |||||||||
| City: | BARTLETT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601032304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309658182 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5841 S MARYLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606371443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888240200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2020 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209022234 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.