Provider Demographics
NPI:1710865654
Name:CRUZ, JOHNNY JOE JR (MSN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:JOE
Last Name:CRUZ
Suffix:JR
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 GRAHAM DR STE 150
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3467
Mailing Address - Country:US
Mailing Address - Phone:281-351-5174
Mailing Address - Fax:
Practice Address - Street 1:506 GRAHAM DR STE 150
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3467
Practice Address - Country:US
Practice Address - Phone:281-351-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily