Provider Demographics
NPI:1063136257
Name:CRUZADO, IRISELIS (PA)
Entity type:Individual
Prefix:
First Name:IRISELIS
Middle Name:
Last Name:CRUZADO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 MAYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5951
Mailing Address - Country:US
Mailing Address - Phone:407-754-6325
Mailing Address - Fax:
Practice Address - Street 1:1300 N WEST SHORE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4629
Practice Address - Country:US
Practice Address - Phone:813-636-8300
Practice Address - Fax:813-636-8301
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant