Provider Demographics
NPI:1548088164
Name:CRUZ, LIVAN (ARNP)
Entity type:Individual
Prefix:
First Name:LIVAN
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30745 SW 158TH PATH
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4305
Mailing Address - Country:US
Mailing Address - Phone:786-718-3417
Mailing Address - Fax:
Practice Address - Street 1:30745 SW 158TH PATH
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4305
Practice Address - Country:US
Practice Address - Phone:786-718-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily