Provider Demographics
NPI:1093441172
Name:DE LA CRUZ, ANNETTE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4456 LOCKHILL SELMA RD STE 9
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3992
Mailing Address - Country:US
Mailing Address - Phone:210-233-7063
Mailing Address - Fax:
Practice Address - Street 1:4456 LOCKHILL SELMA RD STE 9
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3992
Practice Address - Country:US
Practice Address - Phone:210-233-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily