Ivan De la Cruz
Individual provider Active NPI Athletic Trainer · Lynn Haven, FL
NPI 1871336768 · NPPES record last updated Jun 17, 2024
Key facts
- NPI
- 1871336768
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 1304 Alabama Ave
Lynn Haven, FL 32444-2535 - Phone
- (850) 716-2547
- NPI assigned
- Jun 17, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
1304 Alabama Ave
Lynn Haven, FL 32444-2535
Mailing address
1304 Alabama Ave
Lynn Haven, FL 32444-2535
Phone (850) 716-2547
Other providers in Lynn Haven, FL
- Kristin Craig
- Maria Gina Cruz
- Dale E Mortenson DC PA
- Tisha Davis
- Brian R Davison
- Lori L Deaton
- Sylvia Raye Dee
- Christina M Deegins
- Derek H. Wall DDS PA
- Robert Joseph Doheny Jr.
All providers in Lynn Haven, FL · Athletic Trainer in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.