Provider Demographics
NPI:1548653058
Name:CRUZ, MARISSA G (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:G
Last Name:CRUZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MS, CNS
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:206-860-5414
Mailing Address - Fax:
Practice Address - Street 1:3901 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4918
Practice Address - Country:US
Practice Address - Phone:425-317-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-07
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61216498363LA2100X, 363LA2100X
OR10030517363LA2100X
CA95029705363LA2100X
WA60497895163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10030517OtherOREGON STATE BOARD OF NURSING
WAAP61216498OtherWASHINGTON STATE BOARD OF NURSING