Provider Demographics
NPI:1386739050
Name:CRUZ, TINA (MS SLP)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 TROON TRCE
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4318
Mailing Address - Country:US
Mailing Address - Phone:407-721-4054
Mailing Address - Fax:407-386-7928
Practice Address - Street 1:968 TROON TRCE
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4318
Practice Address - Country:US
Practice Address - Phone:407-721-4054
Practice Address - Fax:407-386-7928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ3924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891585700Medicaid