Provider Demographics
NPI:1992056436
Name:CRUZ, YVETTE N (NP-C)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:N
Last Name:CRUZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6261
Mailing Address - Country:US
Mailing Address - Phone:912-352-8346
Mailing Address - Fax:
Practice Address - Street 1:4750 WATERS AVE STE 500
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6261
Practice Address - Country:US
Practice Address - Phone:912-443-9409
Practice Address - Fax:912-443-9410
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169066363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003153677BMedicaid
GA003153677FMedicaid