Provider Demographics
NPI:1598217176
Name:CRUZ, ISAIAH ANTONIO (PMHNP, FNP-C)
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:ANTONIO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PMHNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10629 SPRINGTIDE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9441
Mailing Address - Country:US
Mailing Address - Phone:419-576-7973
Mailing Address - Fax:
Practice Address - Street 1:1390 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5404
Practice Address - Country:US
Practice Address - Phone:877-627-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006657A363L00000X
WAAP61127400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner