Individual provider Active NPI

Evelyn Cruz, APRN

  • Nurse Practitioner
  • Plantation, FL
National Provider Identifier
1417015447
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN3055982 Issued in FL
Practice address
9611 W Broward Blvd
Plantation, FL 33324-2334
Phone
(954) 424-7000
Fax
(954) 424-6003
NPI assigned
Dec 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X APRN3055982 FL
Nurse Practitioner 363L00000X APRN3055982 FL Primary

Addresses

Primary practice location

9611 W Broward Blvd
Plantation, FL 33324-2334

Mailing address

900 S Pine Island Rd Ste 800
Plantation, FL 33324-3923
Phone (305) 245-8050

Other practice location 1

4972 Town Center Pkwy Unit 301
Jacksonville, FL 32246-8596
Phone (904) 642-6100

Other practice location 2

11260 Sullivan St
Riverview, FL 33578-2140
Phone (813) 689-7571

Other identifiers 1

IdentifierTypeStateIssuer
024137400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
APRN3055982FLMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saltzman, Tanis, Pittell, Levin and Jacobson, LLC PastSince Jul 25, 2019 Accepting new patients
Florida Arthritis & Rheumatology Associates, LLC Past Accepting new patients
American Arthritis & Rheumatology Associates LLC Past Accepting new patients
Saltzman, Tanis, Pittell, Levin and Jacobson PastSince Jul 25, 2019 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ecruz@pa.trimed.direct-ci.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1417015447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S PINE ISLAND RD STE 800",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243923",
            "telephone_number": "305-245-8050",
            "fax_number": "305-245-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9611 W BROWARD BLVD",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242334",
            "telephone_number": "954-424-7000",
            "fax_number": "954-424-6003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4972 Town Center Pkwy Unit 301",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322468596",
            "country_code": "US",
            "telephone_number": "904-642-6100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11260 Sullivan St",
            "address_purpose": "LOCATION",
            "city": "Riverview",
            "state": "FL",
            "postal_code": "335782140",
            "country_code": "US",
            "telephone_number": "813-689-7571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "EVELYN",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "APRN3055982",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN3055982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024137400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.