Individual provider Active NPI

Glorymardy Cruz, FNP-BC

  • Family Nurse Practitioner
  • Kingston, PA
National Provider Identifier
1124786041
Registry record updated May 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP024256 Issued in PA
Practice address
511 Pierce St
Kingston, PA 18704-5731
Phone
(570) 714-3333
NPI assigned
Dec 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP024256 PA Primary

Addresses

Primary practice location

511 Pierce St
Kingston, PA 18704-5731

Mailing address

PO Box 1885
Kingston, PA 18704-0885
Phone (570) 288-8881

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221208003289 PA Practitioner - Nurse Practitioner 2466821715 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Children'S Service Center of Wyoming Valley IncGroup PAC ID 1052567617, 32 clinicians
Medical Center of Northeastern PA LLCGroup PAC ID 1951579762, 6 clinicians
Ultra Care Urgent and Family CareGroup PAC ID 1951662063, 4 clinicians

Practice addresses (Care Compare)

335 S Franklin St
Wilkes Barre, PA 18702-3808
Phone 5708256425581

511 Pierce St
Kingston, PA 18704-5731
Phone (570) 714-3333

Hospital & facility affiliations

  • Wilkes-Barre General Hospital Hospital, Wilkes-Barre, PA, CCN 390137

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Center of Northeastern PA LLC Family Medicine CurrentSince Aug 23, 2022 Accepting new patients
Ultra Care Urgent and Family Care Family Medicine CurrentSince Sep 8, 2022 Accepting new patients
Children'S Service Center of Wyoming Valley, Inc CurrentSince Aug 1, 2025 Accepting new patients
Children'S Service Center of Wyoming Valley, Inc Family Medicine CurrentSince Aug 1, 2025 Accepting new patients
Children'S Service Center of Wyoming Valley, Inc Current Accepting new patients
Portonova Foot and Ankle Specialists LLC PastSince Nov 22, 2020 Accepting new patients

Locations

511 Pierce St
Kingston, PA 18704
Phone (570) 243-3300

1919 Memorial Hwy
Shavertown, PA 18708
Phone (570) 243-3300

133 W Tioga St
Tunkhannock, PA 18657
Phone (570) 836-2722

335 S Franklin St
Wilkes Barre, PA 18702
Phone (570) 825-6425

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778198400000",
    "number": "1124786041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1885",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187040885",
            "telephone_number": "570-288-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 PIERCE ST",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045731",
            "telephone_number": "570-714-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "GLORYMARDY",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-08",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP024256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, PA

Sources for this page

Verify at the official NPI Registry.