Provider Demographics
NPI:1063079234
Name:CRUZA, JIMMY (FNP-C)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:CRUZA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 BLUEBIRD WING ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-4802
Mailing Address - Country:US
Mailing Address - Phone:702-981-2919
Mailing Address - Fax:
Practice Address - Street 1:2 S MAINE AVE BLDG 102-54
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-9404
Practice Address - Country:US
Practice Address - Phone:702-981-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV821250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVMC5656864OtherDEA