Provider Demographics
NPI:1992271688
Name:CRUELL, ANTWAN JAMAL (FNP)
Entity type:Individual
Prefix:
First Name:ANTWAN
Middle Name:JAMAL
Last Name:CRUELL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 SW CARY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6224
Practice Address - Country:US
Practice Address - Phone:919-387-3176
Practice Address - Fax:919-387-3244
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5011149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily