Provider Demographics
NPI:1427096882
Name:KRUIZE, NATALIE ANN (PAC)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ANN
Last Name:KRUIZE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 SE COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6420
Mailing Address - Country:US
Mailing Address - Phone:772-581-3990
Mailing Address - Fax:772-581-3991
Practice Address - Street 1:5850 SE COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6420
Practice Address - Country:US
Practice Address - Phone:772-324-3500
Practice Address - Fax:772-324-3901
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000793363AM0700X
FLPA 9102778363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical