Provider Demographics
NPI:1114744927
Name:QUIROZ, CRISTINA (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:QUIROZ
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 W 145TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 45TH ST STE 4
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3277
Practice Address - Country:US
Practice Address - Phone:219-922-6911
Practice Address - Fax:219-922-6968
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28278391A163W00000X
IN28278391C163W00000X
IN71015941A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300098423Medicaid
IN1104472951OtherANTHEM